Introduction: Handmade polytetrafluoroethylene (PTFE) conduits have similar durability and efficacy compared to commercially available conduits and homografts used for pulmonary valve replacement (PVR) in pediatric right ventricular outflow tract (RVOT) reconstruction. We evaluated the costs related to use of the PTFE conduits compared to commercial grafts. Hypothesis: When compared to commercial grafts in first-time RVOT reconstruction, PTFE conduits have reduced surgical day costs with similar overall hospital costs per day of conduit life. Methods: Data was collected via retrospective chart review of patients < 2 years of age who underwent first-time PVR from 1/2010 - 3/2019. Initial procedure, all day-of-surgery, and subsequent reintervention costs and charges were examined. Patients were followed until conduit explant, patient death, or 3/2020 (whichever came first) and were adjusted to 2020 USD. Results: Of 52 instances of PVR in RVOT reconstruction, 36 (69%) of grafts were PTFE, and 16 (31%) were commercial. There were no statistically significant differences in gestational age; birth weight; weight, height, or age at intervention; hospital or intensive care unit length of stay; conduit life; or bypass, cross-clamp, or intubation duration between the groups. Compared to commercial grafts, PTFE conduits were associated with lower day-of-surgery hospital charge, day-of-surgery estimated cost, and graft/conduit charge. There was a trend toward lower aggregate cost over conduit life (Table). Aggregate cost per day of conduit life was similar between groups ( p = 0.26). Conclusions: In first-time PVR, PTFE conduits have lower initial and reintervention costs compared to commercially available conduits and homografts. In centers with expertise in handmade conduits, these may provide a less expensive alternative to commercial grafts in pediatric patients requiring RVOT reconstruction.

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Mitral regurgitation in the neonatal period is relatively rare. It can be secondary to a congenital malformation of the valve apparatus or mitral valve dysfunction and deformation secondary to myocardial dysfunction or volume load of the left ventricle. Less commonly, it can be due to coronary artery abnormalities leading to mitral valve papillary muscle ischaemia and subsequent dysfunction. Such coronary artery abnormalities include anomalous left coronary artery from pulmonary artery, left main coronary artery atresia, or a thromboembolic phenomenon. In this study, we describe a newborn with a dysplastic aortic valve causing obstruction of the os of the left coronary artery leading to progressive mitral insufficiency.

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