Fate of Homograft versus Polytetrafluoroethylene Right Ventricular to Pulmonary Artery Conduits After Neonatal Truncus Arteriosus Repair: A Case Series
Laura M. Seese1, Harma K. Turbendian2, Carlos Diaz Castrillon1, Victor O. Morell3.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2University of Pittsburgh Medical Center - Wolfson Children's Hospital, Jacksonville, FL, USA, 3University of Pittsburgh Medical Center - The Children's Hospital of PIttsburgh, Pittsburgh, PA, USA.
Background: Right ventricular outflow tract (RVOT) reconstruction with a right ventricular to pulmonary artery (RV-to-PA) conduit remains a source of long-term reintervention and reoperation in truncus arteriosus (TA) repair. Here we evaluate our experience with reintervention in homograft and polytetrafluoroethylene (PTFE) RV-to-PA conduits over a twelve-year period in neonates.
Methods: Primary TA repairs from July 2004 and May 2016 at a single institution were included. Stratification was based on RVOT reconstruction with PTFE or homograft conduit. Primary outcome was operative conduit replacement. The secondary outcomes included the rates and types of catheter-based conduit interventions.
Results: Twenty-nine patients underwent primary TA repair and 89.3% (n=25) patients had RVOT reconstruction with a homograft (28.0%, n=7) or PTFE (72.0%, n=18) conduit. Rates of and median time to reoperation for conduit revision and catheter-based interventions were similar between those with PTFE and homograft conduits (85.7% vs 72.2%, p=0.49 and 100.0% vs 88.9%, p=0.25). In multivariable analysis, conduit size was found to be a predictor of conduit revision (HR 1.66, 95% CI 1.11, 2.49, p=0.02). At 5-year and 10-year follow-up, a mortality benefit was appreciated in patients with PTFE conduits (100.0% vs 71.4%, p=0.02).
Conclusions: PTFE and homograft RVOT reconstruction in neonatal TA repair demonstrate similar durability as defined by reoperation and reintervention rates. There may be a long-term survival benefit with use of a PTFE RV-to-PA conduit. Further studies are necessary to define the optimal method of RVOT reconstruction.
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