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Outcomes following non-valved autologous reconstruction of the right ventricular outflow tract in neonates and infants

Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, United States

Received 18 January 2008; received in revised form 16 June 2008; accepted 23 June 2008.

^_* Corresponding author. Address: Nemours Cardiac Center, Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, United States. Tel.: +1 302 651 6600; fax: +1 302 651 5345. (Email: cderby{at}nemours.org).

Objective: Controversy surrounds the optimal method of establishing right ventricle to pulmonary artery continuity in neonates and infants with congenital heart disease. We reviewed our experience with non-valved autologous reconstruction of the right ventricular outflow tract to determine mid-term outcome and risk factors for reintervention. Methods: Between 1998 and 2006, 34 consecutive patients underwent non-valved autologous right ventricular outflow tract reconstruction. The need for postoperative catheter-based intervention or reoperation was assessed using relevant patient and procedure-related variables. Results: Diagnoses included tetralogy of Fallot with anomalous coronary (n = 3), tetralogy of Fallot with pulmonary atresia (n = 10), truncus arteriosus communis (n = 15), and other (n = 6). Median age at surgery was 5 days (1–270 days). Twenty-six (76%) patients were neonates. Median weight was 3.1 kg (1.8–7.3 kg). At a median follow-up of 43 months (1–90 months), 15 (50%) patients underwent reoperation and 7 (23%) underwent catheter-based intervention, with a total of 16 (53%) undergoing either reoperation or catheter-based intervention. Kaplan–Meier freedom from reintervention at 6 months, 1 year, 3 years, and 5 years was 67%, 47%, 47%, and 35% for truncus arteriosus versus 87%, 82%, 68%, and 65% for diagnoses other than truncus arteriosus (p = 0.05). Conclusions: Mid-term outcome following non-valved autologous reconstruction of the right ventricular outflow tract is satisfactory and constitutes a sound alternative to the use of small-diameter conduits in neonates and infants. In our hands, this strategy favors certain anatomic subtypes. Non-truncus patients have significantly lower rates of reintervention. Technical details associated with the anatomical reconstruction of the posterior autologous pathway may play an important role in outcomes.

Key Words: Congenital heart surgery • Neonatal • Right ventricular outflow tract reconstruction