Conduit-less right ventricle-to-pulmonary artery reconstruction using the left atrial appendage achieved an estimated 5-year freedom from reoperation of 90.9%.
Observational (n=17)
Does conduit-less RV-PA reconstruction using the left atrial appendage provide favorable midterm freedom from reoperation in pediatric patients with congenital heart disease?
Strategic use of the left atrial appendage for conduit-less RV-PA reconstruction is a promising approach that achieves excellent midterm freedom from reoperation in pediatric patients.
Objective To evaluate the surgical strategy and midterm outcomes of a conduit‐less right ventricle‐to‐pulmonary artery (RV‐PA) reconstruction using the left atrial appendage (LAA) for posterior wall augmentation. Methods We retrospectively reviewed 17 consecutive patients (median age: 15.2 months; weight: 8.4 kg) who underwent conduit‐less RV‐PA reconstruction between 2007 and 2025. The LAA was utilized to reconstruct the posterior wall of RV‐PA route via two distinct techniques selected according to native anatomy: Type A (augmentation of the diminutive PA trunk), used when native PA tissue was available, where the LAA was attached to augment the left side of the longitudinally incised PA trunk ( n = 8); and Type B (interposition), used when native PA tissue was absent, requiring the LAA to be interposed as a bridge between the pulmonary bifurcation and the RV incision ( n = 9). The anterior wall was completed with a monocusp‐incorporated transannular patch. Results Primary diagnoses included pulmonary atresia with ventricular septal defect ( n = 11), double‐outlet right ventricle ( n = 3), truncus arteriosus ( n = 2), and tetralogy of Fallot with hypoplastic PA ( n = 1). The median follow‐up was 3.8 years (up to 11.9 years). There were no technique‐specific complications. The median diameter of the reconstructed route was 12 mm. One noncardiac death occurred due to pneumonia. While four patients required catheter interventions for peripheral branch PA stenosis (5‐year freedom from intervention: 61.6%), only one patient required reoperation due to a restrictive monocusp. No interventions were required for the LAA posterior wall itself. The estimated 5‐year freedom from reoperation was 90.9%. Conclusions Strategic use of the LAA for reconstruction of a new RV‐PA route—either by augmentation (Type A) or interposition (Type B)—is a promising conduit‐less approach that achieves favorable midterm freedom from surgical reoperation. Long‐term follow‐up is warranted to evaluate the cumulative lifetime reintervention burden and the theoretical growth potential of this autologous tissue.
Nemoto et al. (Thu,) conducted a observational in Congenital heart disease requiring right ventricle-to-pulmonary artery reconstruction (n=17). Conduit-less right ventricle-to-pulmonary artery reconstruction using the left atrial appendage was evaluated on 5-year freedom from reoperation. Conduit-less right ventricle-to-pulmonary artery reconstruction using the left atrial appendage achieved an estimated 5-year freedom from reoperation of 90.9%.