Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular
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ORIGINAL ARTICLE
Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular Vein and Expanded Polytetrafluoroethylene Conduits Kenta Hirai1 · Kenji Baba1 · Takuya Goto2 · Daiki Ousaka2 · Maiko Kondo1 · Takahiro Eitoku1 · Yasuhiro Kotani2 · Shingo Kasahara2 · Shinichi Ohtsuki1 · Hirokazu Tsukahara1 Received: 3 June 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) conduits have been described as alternatives to the homograft for right ventricular outflow tract (RVOT) reconstruction. This study compared RVOT reconstructions using BJV and ePTFE conduits performed in a single institution. The valve functions and outcomes of patients aged 18 years at the time of surgery, those who underwent re-RVOT reconstruction, and those who transferred hospitals and lost to follow-up after RVOT reconstruction were excluded.
Surgical Procedures All the operations were performed through a median sternotomy with a cardiopulmonary bypass and hypothermia. Intracardiac repair was performed during aortic cross clamping; and conduit implantation, after release of the aortic cross clamp. The distal anastomosis to the pulmonary artery bifurcation was performed first with continuous sutures. After the proximal end of the conduit was cut obliquely, the posterior side was sewn to the incision of the right ventricle with interrupted sutures, and the anterior side was sewn with a continuous suture.
Data Collection The data collected included the diagnosis, previous surgical procedures and catheter interventions, indication for conduit implantation, outcomes, and surgical and catheter interventions after RVOT reconstruction. To assess the degree of pulmonary stenosis (PS) and pulmonary regurgitation (PR), all the patients periodically underwent transthoracic, color flow, pulsed- and continuous-wave Doppler echocardiography. The branch PS grades were classified as mild (peak velocity, 4 m/s). The PR grades were classified as none to trivial, mild, moderate, or severe. All the criteria applied for grading were based on the commonly used guidelines for echocardiograms [14, 15]. The echocardiogram data collected at the latest follow-up were used for statistical analyses. The diameters of the pulmonary arteries were measured immediately proximal to the origin of the first lobar branches bilaterally, and the pulmonary artery index (PAI) was calculated as (right pulmonary artery area + left pulmonary artery area)/body surface area (BSA; mm2/m2) [16]. In the case where the patient had no central pulmonary artery, we measured the diameters of the major aortopulmonary collateral
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Pediatric Cardiology
arteries (MAPCAs) for unifocalization immediately proximal to the origin of the first branches and calculated PAI as (the sum of MAPCA areas)/BSA (mm2/m2). Aneurysmal dilatation of the conduit was defined as follows: the diameter of the most dilated positi
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