Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstruction
Di Pasquale L, Jaeger O, Erdil T, Christmann M, Quandt D, Cesnjevar R, Dave H (2023)
Publication Type: Journal article
Publication year: 2023
Journal
Book Volume: 19
Pages Range: 109-118
DOI: 10.1016/j.xjtc.2023.03.013
Abstract
Objective: Severe right ventricular outflow tract obstruction in tetralogy of Fallot and variants necessitates the use of transannular patch in a significant proportion of children undergoing repair. We have used a Contegra monocusp together with delamination of native leaflet tissue in order to create a functioning pulmonary valve. Methods: In total, 18 (2017-2022) consecutive Contegra monocusp implantations were included. Median age and weight were 3.65 [2.00; 9.43] months and 6.12 [4.30; 8.22] kg, respectively. Nine of 18 patients had undergone palliation. Native pulmonary leaflet tissue was recruited to create a single posterior cusp. Contegra monocusp selection was based on the goal to achieve a neoannulus of Z value ≈ 0. Monocusp sizes implanted were 16 [14; 18] mm. Patch plasty of left pulmonary artery (LPA) (9), right pulmonary artery (RPA) (2), and both LPA-RPA (5) were often performed. Results: All patients survived the operation and were discharged home in good health. Median ventilation time and hospital stay were 2 [1; 9] and 12.5 [9; 54] days, respectively. Follow-up duration was 30.68 [3.47; 60.47] months and 100% complete. One patient with well-corrected right ventricular outflow tract died 9.4 months postoperatively, possibly of aspiration. One child with membranous pulmonary atresia needed reoperation (conduit insertion) at 3.5 months of follow-up. Five needed catheter interventions: supravalvar stent (2), LPA stent (3), and RPA stent (1), most of them in the earlier half of the experience. Pulmonary annulus changed from preoperative –3.91 [–5.98; –2.23] to –0.10 [–1.44; 1.92] at discharge; growing proportionally to –0.13 [–3.52; 2.73] at follow-up. Kaplan–Meier freedom from composite dysfunction was 79.25 (95% confidence interval, +13.68%, –31.44%) at 36 months. Conclusions: Recruitment of native leaflets, optimal Contegra monocusp, and commissuroplasty provide an easily replicable technique for achieving a competent, proportionally growing neopulmonary valve. Longer follow-up is needed to determine its impact on delaying a pulmonary valve replacement. Video Abstract: [Formula presented]
Involved external institutions
Switzerland (CH)How to cite
APA:
Di Pasquale, L., Jaeger, O., Erdil, T., Christmann, M., Quandt, D., Cesnjevar, R., & Dave, H. (2023). Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstruction. JTCVS Techniques, 19, 109-118. https://doi.org/10.1016/j.xjtc.2023.03.013
MLA:
Di Pasquale, Luigi, et al. "Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstruction." JTCVS Techniques 19 (2023): 109-118.
BibTeX: Download