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Right Ventricle to Pulmonary Artery Conduit Size Is Associated with Conduit and Pulmonary Artery Reinterventions After Truncus Arteriosus Repair

      We studied conduit-related risk factors for mortality, conduit reintervention, conduit replacement, and pulmonary artery (PA) reinterventions after truncus repair. Patients who underwent truncus repair at our institution between 1995 and 2019 were studied. Cox proportional hazards modeling evaluated variables for association with mortality, time to conduit reintervention, time to conduit replacement, and time to PA reintervention. Truncus was repaired in 107 patients at median age of 17 days (IQR 9–45). Median follow-up time was 7 years. Aortic homografts were implanted in 57 (53%) patients, pulmonary homograft in 40 (37%), and bovine jugular conduit in 10 (9%). Median conduit size was 11 mm (IQR 10–12) and median conduit Z-score was 1.71 (IQR 1.08–2.34). At 5 years, there was 87% survival, 21% freedom from conduit reinterventions, 37% freedom from conduit replacements, and 55% freedom from PA reinterventions. Conduit size (HR 0.7, 95%CI 0.4–1.4, p=.41) and type (aortic homograft reference; bovine jugular vein graft HR 0.6, 95% CI 0.08-5.2, p=.69; pulmonary homograft HR 0.7, 95% CI 0.2–2.3, p=.58) were not associated with mortality. On multivariate analysis, the hazard for conduit reintervention, conduit replacement, and PA reintervention decreased with increasing conduit Z-score values of 1 to 2.5 (non-linear relationship, p<.01), with little additional reduction in hazard beyond this range. Implantation of a larger conduit within Z-score values of 1 and 2.5 is associated with a decreased hazard for conduit reintervention, conduit replacement, and PA reintervention after truncus repair. The type and size of the conduits did not impact mortality.

      Graphical Abstract

      Keywords

      Abbreviations:

      RV-PA (Right ventricle to pulmonary artery)
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      Linked Article

      • Commentary: Conduits and Splines: Mounting Evidence for an Optimal Conduit Size in Truncus Arteriosus Repair
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          In the preceding paper the surgical team at Texas Children's (TCH) presented its experience with the longevity of the initial conduit after truncus arteriosus repair.1 Their principal finding was that the hazard for conduit reintervention and for conduit replacement decreases between conduit size z=+1 and +2.5, then levels off for z>+2.5. Conduit type did not matter.
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      • Commentary: The Devil in Z Details
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
        • Preview
          Bonilla-Ramirez et al. adeptly present a longitudinal single-center retrospective experience of 107 patients undergoing neonatal truncus arteriosus repair, with the specific objective to evaluate long-term right ventricle-pulmonary artery conduit results.1 The authors are to be commended for their excellent overall outcome, with 87% survival at 5 years. Conduit durability, as measured by both catheter and surgical re-intervention rates, are reported as 21% freedom from conduit intervention and 37% freedom from conduit replacement at 5 years.
        • Full-Text
        • PDF