Alternative techniques of right ventricular outflow tract reconstruction for surgical repair of truncus arteriosus

Abstract

OBJECTIVES This study aimed to evaluate the outcomes and feasibility of different techniques of reconstruction of the right ventricular outflow tract (RVOT) in surgical repair of truncus arteriosus. METHODS We retrospectively reviewed all consecutive patients with truncus arteriosus who underwent successful surgical repair in our centre between 1994 and 2017. We analysed late results according to the type of RVOT repair. RESULTS We collected data from 29 survivors after truncus arteriosus repair. Six (20%) of them were affected by DiGeorge syndrome. The RVOT reconstruction was achieved using a valved conduit in 58.6%, while a direct right ventricle–pulmonary artery (RV–PA) anastomosis, with or without the interposition of the left atrial appendage, was performed in the remaining. At a median follow-up time of 7.9 years (interquartile range 1.8–13.1), 6 patients (3 affected by DiGeorge syndrome) died. Between the 2 groups, there were no differences in terms of the late mortality and onset of adverse events. However, the use of a conduit seemed more prone to reintervention and onset of adverse events. CONCLUSIONS Different RVOT reconstruction techniques are safe and have similar late outcomes. However, use of a direct RV–PA anastomosis and left atrial appendage interposition may reduce the need for reoperation in the long term.

Truncus arteriosus from prenatal diagnosis to clinical outcome: a single-centre experience

“…24 However, when repair is performed early (first weeks of life), this complication does not seem to occur, which could explain that early mortality did not occur in our cohort. 23,27 At latest follow-up, all patients showed good functional capacity (NYHA class I and II), which is in accordance with literature. 22 At a median follow-up of 5.4 years, freedom from any reintervention was 50% and freedom from surgical reintervention was 81%.…”

“…The low number of reinterventions associated with direct reconstruction in our cohort corresponds with the rates reported in literature: freedom from any reintervention of 56%, and freedom from reoperation of approximately 90% 4 years after primary surgery. 23,27,28 Rightsided reintervention rates are more common in patients who received a homograft at initial repair. 29 Once a valve implantation seems indicated, most patients have gained enough weight to receive an adult-size valved conduit.…”

Modified Hand-Sewn Polytetrafluoroethylene Bicuspid Valved Conduit for the Reconstruction of Right Ventricle Outflow Tract in Truncus Arteriosus in Infancy: A Case Report

“…Relatively cumbersome, time-costing [5,6] Modified PTFE conduit Ease of availability, low cost, being immunologically inert, time-saving Undefined indication and contraindication, lack of evidence on safety and efficacy [6,18] RVOT, right ventricle outflow tract; RV-PA, right ventricle to pulmonary artery; PTFE, polytetrafluoroethylene.…”

“…Overall, the comparison between our modified technique and conventional strategies of RVOT reconstruction was summarized in Table 2 (Ref. [1][2][3]5,6,[14][15][16][17][18]).…”

Commentary: Right ventricular outflow tract reconstruction during repair of truncus arteriosus: Everything old is new again

“…For others, this option may still be attractive for its advantages in terms of growth potential and avoidance of obligatory conduit changes. 9,15 Naturally, before one can reap the future benefit of freedom from reoperation, one must first achieve early survival in the acute postoperative period. First things first: live for today.…”