Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect

Abstract

The short lifespan of right ventricle-to-pulmonary artery (RV-PA) conduits used in repairs of complex congenital heart defects makes future surgical replacement inevitable. Percutaneous pulmonary valve implantation (PPVI) now offers an attractive alternative to surgery in some patients. The objectives of this study were to examine the pattern of conduit reoperations, the factors affecting conduit longevity, and to discuss the role of PPVI in these patients. Forty-nine patients (mean age 27 ± 8 years) with pulmonary atresia or pulmonary stenosis with tetralogy of Fallot who underwent surgery for RV-PA conduits from September 1974 to October 2011 were reviewed. A total of 106 RV-PA conduits were implanted, 57 of which were replacements. Second, third, and fourth conduits were required during the follow-up period in 39, 16, and 2 patients, respectively. Freedom from reoperation at 10 years for the first, second, and third conduits was 50%, 74%, and 86%, respectively. Significant independent predictors of shorter conduit longevity included smaller conduit and conduit type (homograft and other vs Dacron). Furthermore, a significant proportion (32 of 57 [56%]) of conduit replacements took place from ages 9 to 18 years. There were 37 adults whose current existing conduits had not yet failed, with 73% (27 of 37) potentially suitable in the future for PPVI on the basis of conduit size of 16 to 27 mm. In conclusion, multiple RV-PA conduit revisions were required in patients who survived to adulthood, with many replacements taking place during adolescence. Most conduits in this adult cohort met size criteria for PPVI, thereby offering these patients a potential alternative to surgical intervention for conduit failure.