Midterm Outcomes of Handmade Pericardial Valved Conduits in Congenital Heart Disease: A Viable Cost-Effective Alternative In Resource-Limited Settings

OBJECTIVES The availability and affordability of conduits have significantly challenged congenital heart surgery in low-resource settings. We present the intermediate-term outcomes of low-cost customized handmade conduits at our institution. METHODS Analysis of our surgical database and hospital information system (2016–2023) was done. Handmade conduits (cost: 30% of commercial conduits) were prepared in the operating room prior to surgery, using bovine pericardium for the conduit body tailored to the exact required diameter, with 0.1 mm PTFE valve leaflets. RESULTS Handmade conduits were implanted in 185 patients [median age: 1.58 years (0.75–6.92), weight: 8.40 kg (6.30–17.03); conduit diameter 15 mm (13–20); cardiopulmonary bypass time 191.5 min (160–238) and cross-clamp time 106.5 min (73.8–145)]. Median ventilation duration was 19 hours (7–39), ICU stay 72 hours (44–120), and hospital stay 15 days (IQR: 11–20); mortality was 3.8%. The median follow-up duration was 29.5 months (14–59.5) for 160 patients. Peak conduit gradient on follow-up was 40 mmHg (IQR: 22.8–63.8). Significant conduit regurgitation was noted in 21.2%. Endocarditis occurred in 7 (4.3%) patients (late in 4, early in 3). Re-interventions included 22 transcatheter procedures [18 balloon, 4 stents] at a median of 24 (12.2–34.7) months from conduit implantation. Of the 160 patients on follow-up, 28 had their conduits replaced at a median of 37 months (21–65 months) from implantation. Freedom from the composite end-point of reintervention/reoperation/death was 94% at 1 year; 70% at 5 years. CONCLUSIONS Handmade pericardial valved conduits are a potentially attractive low-cost alternative to commercially available conduits in low-resource settings.