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Original Articles: Pediatric Cardiac

Right Ventricle to Pulmonary Artery Conduit Augmentation Compared With Replacement in Young Children

^a Departments of Cardiology and Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts
^b Departments of Pediatrics and Surgery, Harvard Medical School, Boston, Massachusetts

Accepted for publication April 27, 2009.

^_* Address correspondence to Dr McElhinney, Department of Cardiology, Children's Hospital, Boston, MA 02115 (Email: doff.mcelhinney{at}cardio.chboston.org).

Background: Targeted outcome data for young children undergoing right ventricle to pulmonary artery conduit reoperation are sparse, as are data on the use of conduit augmentation as an alternative to conduit replacement at the time of first conduit reoperation (conduit 2).

Methods: We conducted a retrospective chart review including baseline data, operative data, and cross-sectional follow-up on children younger than 10 years of age undergoing a first conduit reoperation (n = 180), comparing conduit replacement (n = 147, 82%) with conduit augmentation (n = 33, 18%).

Results: There were no differences between the two groups with respect to age, size, or hemodynamic variables. Augmentation was less often performed in patients with an aortic homograft and by one surgeon. At conduit 2, cardiopulmonary bypass time was longer in replacement patients (101 ± 35 versus 71 ± 34 minutes; p < 0.001); cardiac intensive care unit stay was not different. Early mortality was 0.5%, and overall 10-year survival was 95%. Freedom from reoperation was 80% at 5 years and 39% at 10 years, whereas freedom from reintervention (reoperation or catheter intervention) was 55% at 5 years and 26% at 10 years, with no differences between groups. Aortic homograft as a first conduit was associated with shorter freedom from reoperation. Limiting analysis to conduits that were replaced at conduit 2, undersized conduits were associated with shorter freedom from reoperation and smaller body surface area, and undersized conduits were associated with shorter freedom from reintervention.

Conclusions: Freedom from a second conduit reoperation after a first conduit replacement was shorter in smaller children and undersized conduits. Conduit augmentation offers similar clinical outcomes in selected patients.

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Invited Commentary

James S. Tweddell
Ann. Thorac. Surg. 2009 88: 580. [Extract] [Full Text] [PDF]

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