Outcomes after Biventricular Repair Using a Conduit between the Right Ventricle and Pulmonary Artery in Infancy

• Published in: Journal of chest surgery Vol. 57; no. 1; pp. 70 - 78
• Main Authors: Jang, Dong Hee, Kim, Dong-Hee, Choi, Eun Seok, Yun, Tae-Jin, Park, Chun Soo
• Format: Journal Article
• Language: English
• Published: The Korean Society for Thoracic and Cardiovascular Surgery 05-01-2024; Korean Society for Thoracic & Cardiovascular Surgery; 대한심장혈관흉부외과학회
• Subjects: Clinical Research; conduit diameter z-score; conduit dysfunction; conduit reintervention; infancy; right ventricle to pulmonary artery conduit; 흉부외과학
• ISSN: 2765-1606; 2765-1614
• DOI: 10.5090/jcs.23.107

Background: This study investigated the outcomes of biventricular repair using right ventricle to pulmonary artery (RV-PA) conduit placement in patients aged <1 year. Methods: Patients aged <1 year who underwent biventricular repair using an RV-PA conduit between 2011 and 2020 were included in this study. The outcomes of interest were death from any cause, conduit reintervention, and conduit dysfunction (peak velocity of ≥3.5 m/sec or moderate or severe regurgitation). Results: In total, 141 patients were enrolled. The median age at initial conduit implantation was 6 months. The median conduit diameter z-score was 1.3. The overall 5-year survival rate was 89.6%. In the multivariable analysis, younger age (p=0.006) and longer cardiopulmonary bypass time (p=0.001) were risk factors for overall mortality. During follow-up, 61 patients required conduit reintervention, and conduit dysfunction occurred in 68 patients. The 5-year freedom from conduit reintervention and dysfunction rates were 52.9% and 45.9%, respectively. In the multivariable analysis, a smaller conduit z-score (p<0.001) was a shared risk factor for both conduit reintervention and dysfunction. Analysis of variance demonstrated a nonlinear relationship between the conduit z-score and conduit reintervention or dysfunction. The hazard ratio was lowest in patients with a conduit z-score of 1.3 for reintervention and a conduit z-score of 1.4 for dysfunction. Conclusion: RV-PA conduit placement can be safely performed in infants. A significant number of patients required conduit reintervention and had conduit dysfunction. A slightly oversized conduit with a z-score of 1.3 may reduce the risk of conduit reintervention or dysfunction.