Predictors of Reintervention Following Non-valved Autologous Reconstruction of the Right Ventricular Outflow Tract in Neonates and Infants.
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Background: Controversy surrounds the optimal method of establishing right ventricle to pulmonary artery continuity in neonates and infants with congenital heart disease. We reviewed our experience with non-valved autologous reconstruction of the right ventricular outflow tract (RVOT) to determine risk factors for reintervention.
Methods: Between 1998 and 2005, 85 consecutive patients underwent autologous RVOT reconstruction. Perioperative variables were assessed regarding the need for postoperative catheter-based intervention or reoperation by univariate, multivariable and actuarial analyses. Diagnoses included tetralogy of Fallot with pulmonary stenosis (TOF/PS, n=53), tetralogy of Fallot with pulmonary atresia (TOF/PA, n=11), truncus arteriosus (TAC, n=15), and other (n=6). Median age at surgery was 11.5 days (1 to 270). Sixty-four children (74%) were neonates. Median weight was 3.3 kg (1.8-12.4).
Results: At a median follow-up of 40 months (1 to 90), 12 patients (15%) underwent reoperation, 9 (11.2%) underwent catheter-based intervention (CBI), and 10 (12.5%) underwent both. Risk factors for reintervention included anatomic diagnosis (p 0.01), presence of coronary anomaly (p 0.04), weight < 2.5 kg (p 0.02), and requirement for preoperative prostaglandin (p 0.007). Patients undergoing heterotopic reconstruction were much more likely to require conduit reintervention than those with orthotopic reconstructions (OR 20.73, CI 3.39-126.4). Kaplan-Meier freedom from reintervention at 6 months, 1 year and 3 years was 60%, 46%, and 46% for TAC versus 86%, 83%, and 72% for non-TAC (p 0.006).
Conclusions: Predictors of reintervention following non-valved autologous reconstruction of the RVOT include diagnosis of TAC, coronary anomalies, prostaglandin-dependent pulmonary blood flow, weight < 2.5 kg and heterotopic reconstructions. Alternative methods of reconstruction may be considered in these patients, especially in the subgroup requiring heterotopic reconstruction.
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