Long-Term Outcomes After Right Ventricular Outflow Tract Conduit Placement: Outcomes of Right Ventricular Outflow Conduits

Juthamas Hannarong; Teerapong Tocharoenchok

doi:10.33192/smj.v75i6.261096

Authors

Juthamas Hannarong Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Teerapong Tocharoenchok Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok

DOI:

https://doi.org/10.33192/smj.v75i6.261096

Keywords:

allografts, heterografts, reoperation, survival analysis, ventricular outflow obstruction

Abstract

Objective: Our aim was to report on the long-term outcomes of patients who underwent RV-PA conduit placement at our institute.

Materials and Methods: We retrospectively reviewed 407 RV-PA conduit placements from January 1997 to December 2018. The primary outcomes were freedom from and risk factor(s) for conduit re-operation. The secondary outcomes were survival, freedom from conduit dysfunction and conduit-related catheter intervention.

Results: Of all the included patients, 209 were male (51.4%) and the median age at the operation was nine years (IQR 6, 18 years). The most commonly used conduit types were bovine jugular vein conduit (125, 30.7%), pulmonary homograft (122, 30.0%), and aortic homograft (76, 18.7%). The median follow-up time was 5.1 years (IQR 0.9, 9.2 years). The overall survival was 92.2% at 5 years. Freedom from re-operation was 95.4% and 84.2%, at 5 and 10 years. Factors related to conduit reoperation were age at operation less than 1 year, diagnosis rather than pulmonary atresia or stenosis, conduit size less than 18 mm, and conduit z-score greater than 3 (all p<0.01). In multivariate analysis, a significant contributing factor for re-operation was small conduit size (13 mm or smaller; HR 6.87 (95%CI 2.36, 20.01); p<0.001, 14–17 mm; HR 3.20 (95%CI 1.28, 8.00); p=0.013). Freedom from conduit dysfunction was 84.4% and 61.6% at 5 and 10 years. Freedom from conduit intervention was 94.4% and 89.3% at 5 and 10 years.

Conclusion: Our study showed that patients had excellent survival with acceptable freedom from re-operation despite deteriorated conduit function. Small conduit size is associated with re-operation.

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