title: Outcomes following non-valved autologous reconstruction of the right ventricular outflow tract in neonates and infants.
abstract: OBJECTIVE
  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 to determine mid-term outcome and risk factors for reintervention.
  
  
  METHODS
  Between 1998 and 2006, 34 consecutive patients underwent non-valved autologous right ventricular outflow tract reconstruction. The need for postoperative catheter-based intervention or reoperation was assessed using relevant patient and procedure-related variables.
  
  
  RESULTS
  Diagnoses included tetralogy of Fallot with anomalous coronary (n=3), tetralogy of Fallot with pulmonary atresia (n=10), truncus arteriosus communis (n=15), and other (n=6). Median age at surgery was 5 days (1-270 days). Twenty-six (76%) patients were neonates. Median weight was 3.1kg (1.8-7.3kg). At a median follow-up of 43 months (1-90 months), 15 (50%) patients underwent reoperation and 7 (23%) underwent catheter-based intervention, with a total of 16 (53%) undergoing either reoperation or catheter-based intervention. Kaplan-Meier freedom from reintervention at 6 months, 1 year, 3 years, and 5 years was 67%, 47%, 47%, and 35% for truncus arteriosus versus 87%, 82%, 68%, and 65% for diagnoses other than truncus arteriosus (p=0.05).
  
  
  CONCLUSIONS
  Mid-term outcome following non-valved autologous reconstruction of the right ventricular outflow tract is satisfactory and constitutes a sound alternative to the use of small-diameter conduits in neonates and infants. In our hands, this strategy favors certain anatomic subtypes. Non-truncus patients have significantly lower rates of reintervention. Technical details associated with the anatomical reconstruction of the posterior autologous pathway may play an important role in outcomes.
authors.affiliation: Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, United States. cderby@nemours.org
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Derby
authors.forename: Jacek
authors.initials: J
authors.lastname: Kolcz
authors.forename: Samuel
authors.initials: S
authors.lastname: Gidding
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
mesh_terms: D004812:Epidemiologic Methods; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018633:Pulmonary Atresia / Q000601:surgery; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000601:surgery; D014188:Transposition of Great Vessels / Q000601:surgery; D016896:Treatment Outcome; D014339:Truncus Arteriosus, Persistent / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000601:surgery*