The Autologous Pericardial Valved Conduit for Right Ventricular Outflow Tract Reconstruction

Abstract

The repair of many complex congenital heart malformations requires the use of conduits to connect the venous ventricle to the pulmonary artery. After extensive experience with the use of pericardium for reconstruction of the right ventricular outflow tract in tetralogy of Fallot, since June 1983 we have been constructing a fresh autologous valved pericardial conduit to connect the venous ventricle with the pulmonary artery. The objective was and still is to reproduce the excellent long-term results of untreated autologous pericardial patches and unvalved conduits, obtaining adequate valve competence for the first postoperative months. Following our original description of the technique and further publication of the long-term follow-up results, this article will cover the technique of conduit construction. Table 1Size of The Pericardium Required According to The Selected Conduit DiameterRectangleTrapezoidDiameter (mm)Width of Pericardium (mm) (A-A')Height of Valves (mm) (h)Lesser Base (mm)Wider Base (mm) (a-a')12.038.011.038.042.014.044.012.544.048.516.051.013.551.056.018.056.515.056.562.020.063.016.063.069.0 Open table in a new tab Between June 1983 and December 2002, 138 autologous pericardial conduits were placed in the pulmonary position. Diagnosis included D-transposition of great arteries (n = 45 patients), truncus arteriosus (n = 30), L-transposition of great arteries (n = 28), tetralogy of Fallot, pulmonary atresia with ventricular septal defect (n = 25), and double-outlet ventricle (n = 10). Implantation age ranged from 15 days to 24 years (mean 2.9 years). Median conduit diameter was 15 mm. There were 19 (13.7%) early deaths, Of the patients, 29% had trivial, 59% mild, 9% moderate, and 3% severe pulmonary regurgitation during the early postoperative period. The 119 survivors were monitored from 1 to 19 years (mean 9.8). There were 6 late deaths. Mean conduit diameter at implantation was 16 mm, increasing to 17.9 mm at last evaluation (P < 0.0001). There were 12 reoperations, with only 3 conduit replacements. Freedom from conduit related reintervention at 5, 10, and 15 years was 90%, 81%, and 77%, respectively. In conclusion, autologous pericardial valved conduits provide good early and excellent long-term results.