Right ventricular outflow tract reconstruction in cyanotic congenital heart disease: A single center comparison between homograft and handmade polytetrafluoroethylene tri-leaflet valved conduit.

Abstract

Background: The comparative clinical outcomes of homograft (HG) and handmade polytetrafluoroethylene (PTFE) tri-leaflet valved conduit for right ventricular outflow tract reconstruction (RVOTR) in children with cyanotic congenital heart diseases remain unclear.

Methods: We reviewed 265 consecutive patients (aged <14 years old) with cyanotic congenital heart diseases who underwent surgical intervention from 2015 to 2025 in our center (HG n = 141, PTFE n = 124). Competing risk analysis was performed for perioperative mortality, early reintervention, and re-operative conduit replacement during follow-up.

Results: There were five early deaths (1.9 %). Multivariate analysis revealed a significant relationship between early mortality and preoperative left ventricular ejection fraction [hazard ratio (HR), 0.879; 95 % confidence interval (CI), 0.777-0.993; p = 0.039]. During a median follow-up of 45 months (range, 1-96), six patients (2.3 %) had reintervention on pulmonary artery by percutaneous balloon pulmonary dilation in the early postoperative period (average 7.8 months). Compared with HG conduit, patients in the PTFE group demonstrated longer conduit durability (p = 0.013) and lower reoperation rate (p = 0.049) during follow-up. Overall, freedom from reoperation for conduit dysfunction was no different for both conduits (p = 0.037). Freedom from re-operative conduit replacement at 3 and 5 years in the PTFE group was 95.2 % and 91.8 %; 90.3 % and 81.2 % in the HG group, respectively without significant difference (p = 0.37). Multivariate analysis revealed a significant relationship between reoperation and cardiopulmonary bypass time (HR, 0.989; 95 % CI, 0.979-0.999; p = 0.036), conduit size/body surface area > 25.77 mm/m² (HR, 0.152; 95 % CI, 0.038-0.614; p = 0.008) and PTFE conduit (HR, 0.350; 95 % CI, 0.127-0.964; p = 0.042). Patients aged >34 months were associated with longer freedom from reoperation (p = 0.013).

Conclusion: We demonstrate excellent outcomes for RVOTR in pediatric patients with cyanotic congenital heart diseases. The handmade PTFE tri-leaflet valved conduit showed better results for reoperation and conduit durability. Younger age showed worse survival without reoperation for both conduits.