Durability of Aortic Homografts in Pulmonary Atresia and Major Aortopulmonary Collateral Arteries.
World J Pediatr Congenit Heart Surg
; : 21501351241263752, 2024 Aug 21.
Article
in En
| MEDLINE
| ID: mdl-39166263
ABSTRACT
Objectives:
It is well-known that right ventricle-to-pulmonary artery homograft conduit durability is worse for smaller conduits and smaller/younger patients. However, there is limited literature on age and conduit-size specific outcomes, or on the role of conduit oversizing.Methods:
Patients diagnosed with tetralogy of Fallot and major aortopulmonary collateral arteries undergoing right ventricular outflow tract (RVOT) reconstruction with a valved aortic homograft conduit from November 2001 through March 2023, at our institution were included. Conduits were grouped and evaluated by diameter, diameter Z-score, and patient age at implant. The primary time-related outcome was freedom from RVOT reintervention. Factors associated with freedom from time-related outcomes were assessed with univariable Cox regression analysis.Results:
A total of 863 RVOT conduits were implanted in 722 patients. On multivariable analysis, younger age, male sex, Alagille syndrome, smaller diameter of the conduit, and smaller Z-score were associated with shorter freedom from reintervention. Among patients with smaller diameter conduits, larger Z-scores were associated with longer freedom from conduit reintervention (P < .001). Transcatheter interventions were commonly used to extend conduit lifespan across ages and conduit sizes.Conclusions:
Larger conduit diameter, older age, and higher conduit Z-score were associated with longer freedom from reintervention in patients undergoing RVOT reconstruction in this cohort. Oversizing of conduits, even beyond a Z-score of 4, is generally appropriate.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
World J Pediatr Congenit Heart Surg
Year:
2024
Document type:
Article
Affiliation country:
United States
Country of publication:
United States