Alternative Nonvalved Techniques for Repair of Truncus Arteriosus: Long-Term Results

Results of Primary Repair Versus Shunt Palliation in Ductal Dependent Infants With Pulmonary Atresia and Ventricular Septal Defect

“…In addition, we identified that the use of TAP was associated with lower RVOT reoperation risk than RV-PA conduit. This is similar to valveless repair of different cardiac anomalies such as truncus arteriosus and transposition of the great arteries plus pulmonary stenosis that has been shown to be associated with superior freedom from RVOT reoperation [13][14][15][16]. This superior freedom from reoperation is related to the fact that pulmonary regurgitation is tolerated for many years before reoperation is needed as compared with stenosis as a result to a degenerated small RV-PA conduit that requires earlier reoperation.…”

Right Ventricular Outflow Tract Reconstruction in Patients With Persistent Truncus Arteriosus A 15-Year Experience in a Single Japanese Center

“…Since the last echocardiographic analysis showed preserved RV wall motion and acceptable truncal and conduit regurgitation or stenosis, progressive obstruction of the RVOT and/or peripheral PAs is definitely the chief factor compromising the long-term outcome in patients with PTA in our series, and therefore the discussion should be focused on how to improve RVOT reconstruction to minimize the risk of re-intervention. RVOT reconstruction by direct anastomosis, which was first proposed by Reid et al, 13 and later popularized by Berbero-Marcial et al in the early 1990s, 14,15 has been used in several institutes for selected patients [5][6][7] (Table 2). Among the large clinical series of patients with PTA reported in the past decade, 5-7,21-25 4 institutes have used this technique, but surgical results have been inconsistent among the series.…”

“…The most attractive advantage of direct anastomosis is preserving the growth potential of the native PA, thereby theoretically reducing or even avoiding re-operation; 6,7,14,15 however, little evidence has been shown that the native PA actually 'grows' after this procedure. Fujiwara et al showed that the diameters of the reconstructed main PAs increased from 10-18 mm to 18-21 mm at the median follow-up period of 2 years in 4 of 5 cases of various types of congenital heart diseases repaired by direct anastomosis, including 1 patient with PTA; 16 however, none of the large series have detected or evaluated the growth of the reconstructed main PA. [5][6][7] We did not evaluate whether the reconstructed main PAs grew over time, but the growth potential, if any, certainly did not contribute to the reduction of the re-intervention rate in this study.…”

“…In 10 patients, the posterior wall of the PA was directly anastomosed to the RVOT according to the technique described by Barbero-Marcial et al, 14,15 whereas either the left atrial appendage or a homograft patch was interposed to reconstruct the posterior wall of the RVOT in 2 patients with type II PTA. The anterior wall was reconstructed either with a bovine pericardial patch having a monocusp valve (n=3), or with a handmade pericardial patch with a polytetrafluoroethylene (PTFE) monocusp (n=9).…”

“…5,6,12 Reconstruction of the RVOT by direct anastomosis between the RVOT and PA has emerged as a viable alternative in PTA repair that does not need homografts and also theoretically preserves the growth potential of the native PA thereby reducing re-operation rates. [13][14][15][16] Given the limited availability of homografts, and the growth potential of the native PA, over the past decade we have consistently reconstructed the RVOT in patients with PTA by means of direct anastomosis. This study was undertaken to analyze our 15-year experience in PTA repair using a consistent policy of RVOT reconstruction.…”