Clinical study of right ventricular outflow tract reconstruction for complex congenital heart disease—a single-center 10-year follow-up analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Kai ,  ZHENG Jinghao , ZHU Zhongqun , PAN Yanjun , HE Xiaomin , XU Zhiwei , LIU Jinfen

Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, P.R.China;

Corresponding author：

ZHENG Jinghao, Email: zhengjh210@163.com

Keywords：

Complex congenital heart disease; right ventricular outflow tract reconstruction; autologous tissue; extracardiac conduit

DOI：

10.7507/1007-4848.201805018

Video：

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Objective To assess the mid- and long-term outcomes of right ventricular outflow tract reconstruction for children with congenital heart disease. Methods We retrospectively analyzed the clinical data of 3 138 children with complex congenital heart disease in right heart system admitted to our hospital from January 2007 to January 2017. There were 1 660 males and 1 478 females. The age at surgery was 9 days to 84 months, and the body weight was 2.2 to 28.6 kg. Pulmonary patch enlargement was performed in 2 335 patients (1 477 patients of valve-sparing repair and 858 patients of transannular repair); autologous tissue (direct anastomosis, left auricle or pericardial conduit) was used to connect with right ventricle in 289 patients; extracardiac conduits were used for reconstruction in 514 patients. Results There were 181 in-hospital deaths with a mortality of 5.8%. The early postoperative causes of death were low cardiac output syndrome (LCOS), severe pulmonary hypertension and right heart failure. Fifteen patients died of cardiac insufficiency or sudden death during follow-up (6–27 months postoperatively). The echocardiography showed 408 patients with right ventricular outflow tract obsturction (RVOTO), 340 patients with pulmonary trunk or branches stenosis, 609 with pulmonary regurgitation (morderate or severe). 12.6% (394/3 138) of patients underwent reintervention or reoperation with 39 deaths. About 92.4% of patients exhibited an improvement of New York Heart Association (NYHA) functional class from Ⅲ or Ⅳ preoperatively to Ⅰ or Ⅱ at follow-up. Conclusion The anatomical structure of right ventricular outflow tract is complicated and various, and each operation method has different strengths and favorable outcomes. The operation should be individually designed according to pathological types, anatomical features, clinical symptoms and operation conditions.

Citation： LUO Kai, ZHENG Jinghao, ZHU Zhongqun, PAN Yanjun, HE Xiaomin, XU Zhiwei, LIU Jinfen. Clinical study of right ventricular outflow tract reconstruction for complex congenital heart disease—a single-center 10-year follow-up analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(2): 125-131. doi: 10.7507/1007-4848.201805018 Copy

1.	He GW. Current strategy of repair of tetralogy of Fallot in children and adults: emphasis on a new technique to create a monocusp-patch for reconstruction of the right ventricular outflow tract. J Card Surg, 2008, 23(6): 592-599.
2.	Sasikumar N, Ramanan S, Rema KM, et al. Prosthetic reconstruction of bicuspid pulmonary valve in tetralogy of Fallot. Asian Cardiovasc Thorac Ann, 2014, 22(4): 436-441.
3.	Lee C, Lee CH, Kwak JG, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg, 2013, 43(3): 468-472.
4.	Sasson L, Houri S, Raucher SA, et al. Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction. Eur J Cardiothorac Surg, 2013, 43(4): 743-751.
5.	Pande S, Sharma JK, Siddartha CR, et al. Fresh autologous pericardium to reconstruct the pulmonary valve at the annulus when tetralogy of Fallot requires a transannular patch at midterm. Tex Heart Inst J, 2016, 43(3): 207-213.
6.	Isomatsu Y, Shin'Oka T, Aoki M, et al. Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair. Ann Thorac Surg, 2004, 78(1): 173-180.
7.	Gerelli S, Van SM, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): 278-288.
8.	Luo K, Zheng J, Zhu Z, et al. Outcomes of right ventricular outflow tract reconstruction for children with persistent truncus arteriosus: a 10-year single-center experience. Pediatr Cardiol, 2017, 39(12): 1-10.
9.	Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of Fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11): 1638-1643.
10.	胡小松, 杨克明, 李守军, 等. 同种带瓣管道用于右心室流出道重建的中期效果. 中国循环杂志, 2016, 31(4): 385-388.
11.	Schiller O, Sinha P, Zurakowski D, et al. Reconstruction of right ventricular outflow tract in neonates and infants using valved cryopreserved femoral vein homografts. J Thorac Cardiovasc Surg, 2014, 147(3): 874-879.
12.	Kumar TK, Bricenomedina M, Sathanandam S, et al. Femoral vein homograft as right ventricle to pulmonary artery conduit in stage 1 Norwood operation. Ann Thorac Surg, 2017, 103(6): 1969-1974.
13.	Fiore AC, Ruzmetov M, Huynh D, et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. Eur J Cardiothorac Surg, 2010, 38(3): 318-325.
14.	Prior N, Alphonso N, Arnold P, et al. Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg, 2011, 141(4): 983-987.
15.	Sandica E, Boethig D, Blanz U, et al. Bovine jugular veins versus homografts in the pulmonary position: an analysis across two centers and 711 patients-conventional comparisons and time status graphs as a new approach. Thorac Cardiovasc Surg, 2015, 64(1): 25-35.
16.	Ugaki S, Rutledge J, Al AM, et al. An increased incidence of conduit endocarditis in patients receiving bovine jugular vein grafts compared tocryopreserved homograft for right ventricular outflow reconstruction. Ann Thorac Surg, 2015, 99(1): 140-146.
17.	Takahashi Y, Tsutsumi Y, Monta O, et al. Expanded polytetrafluoroethylene-valved conduit with bulging sinuses for right ventricular outflow tract reconstruction in adults. Gen Thorac Cardiovasc Surg, 2010, 58(1): 14-18.
18.	Shinkawa T, Tang X, Gossett JM, et al. Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2015, 100(1): 129-137.
19.	Shinkawa T, Chipman C, Bozzay T, et al. Outcome of right ventricle to pulmonary artery conduit for biventricular repair. Ann Thorac Surg, 2015, 99(4): 1357-1366.
20.	Yamashita E, Yamagishi M, Miyazaki T, et al. Smaller-sized expanded polytetrafluoroethylene conduits with a fan-shaped valve and bulging sinuses for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2016, 102(4): 1336-1344.

1. He GW. Current strategy of repair of tetralogy of Fallot in children and adults: emphasis on a new technique to create a monocusp-patch for reconstruction of the right ventricular outflow tract. J Card Surg, 2008, 23(6): 592-599.
2. Sasikumar N, Ramanan S, Rema KM, et al. Prosthetic reconstruction of bicuspid pulmonary valve in tetralogy of Fallot. Asian Cardiovasc Thorac Ann, 2014, 22(4): 436-441.
3. Lee C, Lee CH, Kwak JG, et al. Bicuspid pulmonary valve implantation using polytetrafluoroethylene membrane: early results and assessment of the valve function by magnetic resonance imaging. Eur J Cardiothorac Surg, 2013, 43(3): 468-472.
4. Sasson L, Houri S, Raucher SA, et al. Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction. Eur J Cardiothorac Surg, 2013, 43(4): 743-751.
5. Pande S, Sharma JK, Siddartha CR, et al. Fresh autologous pericardium to reconstruct the pulmonary valve at the annulus when tetralogy of Fallot requires a transannular patch at midterm. Tex Heart Inst J, 2016, 43(3): 207-213.
6. Isomatsu Y, Shin'Oka T, Aoki M, et al. Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair. Ann Thorac Surg, 2004, 78(1): 173-180.
7. Gerelli S, Van SM, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): 278-288.
8. Luo K, Zheng J, Zhu Z, et al. Outcomes of right ventricular outflow tract reconstruction for children with persistent truncus arteriosus: a 10-year single-center experience. Pediatr Cardiol, 2017, 39(12): 1-10.
9. Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of Fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11): 1638-1643.
10. 胡小松, 杨克明, 李守军, 等. 同种带瓣管道用于右心室流出道重建的中期效果. 中国循环杂志, 2016, 31(4): 385-388.
11. Schiller O, Sinha P, Zurakowski D, et al. Reconstruction of right ventricular outflow tract in neonates and infants using valved cryopreserved femoral vein homografts. J Thorac Cardiovasc Surg, 2014, 147(3): 874-879.
12. Kumar TK, Bricenomedina M, Sathanandam S, et al. Femoral vein homograft as right ventricle to pulmonary artery conduit in stage 1 Norwood operation. Ann Thorac Surg, 2017, 103(6): 1969-1974.
13. Fiore AC, Ruzmetov M, Huynh D, et al. Comparison of bovine jugular vein with pulmonary homograft conduits in children less than 2 years of age. Eur J Cardiothorac Surg, 2010, 38(3): 318-325.
14. Prior N, Alphonso N, Arnold P, et al. Bovine jugular vein valved conduit: up to 10 years follow-up. J Thorac Cardiovasc Surg, 2011, 141(4): 983-987.
15. Sandica E, Boethig D, Blanz U, et al. Bovine jugular veins versus homografts in the pulmonary position: an analysis across two centers and 711 patients-conventional comparisons and time status graphs as a new approach. Thorac Cardiovasc Surg, 2015, 64(1): 25-35.
16. Ugaki S, Rutledge J, Al AM, et al. An increased incidence of conduit endocarditis in patients receiving bovine jugular vein grafts compared tocryopreserved homograft for right ventricular outflow reconstruction. Ann Thorac Surg, 2015, 99(1): 140-146.
17. Takahashi Y, Tsutsumi Y, Monta O, et al. Expanded polytetrafluoroethylene-valved conduit with bulging sinuses for right ventricular outflow tract reconstruction in adults. Gen Thorac Cardiovasc Surg, 2010, 58(1): 14-18.
18. Shinkawa T, Tang X, Gossett JM, et al. Valved polytetrafluoroethylene conduits for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2015, 100(1): 129-137.
19. Shinkawa T, Chipman C, Bozzay T, et al. Outcome of right ventricle to pulmonary artery conduit for biventricular repair. Ann Thorac Surg, 2015, 99(4): 1357-1366.
20. Yamashita E, Yamagishi M, Miyazaki T, et al. Smaller-sized expanded polytetrafluoroethylene conduits with a fan-shaped valve and bulging sinuses for right ventricular outflow tract reconstruction. Ann Thorac Surg, 2016, 102(4): 1336-1344.

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Clinical study of right ventricular outflow tract reconstruction for complex congenital heart disease—a single-center 10-year follow-up analysis

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