Current status and priorities of valved conduits for right ventricle-to-pulmonary artery reconstruction in Japan: a nationwide survey

Right ventricle-to-pulmonary artery reconstruction is essential in congenital heart surgery. In Japan, cryopreserved homograft availability is limited, necessitating alternative materials. This study systematically elucidated the status of right ventricle-to-pulmonary artery conduit use and surgeon priorities in Japan. In 2024, a web-based nationwide survey was conducted by the Japanese Society of Paediatric Cardiology and Cardiac Surgery, targeting 126 institutions. We analyzed data from 2021-2023 regarding primary diagnoses, conduit types, and selection criteria. Responses were obtained from 52 institutions (41.2%), covering 926 cases. Handmade expanded polytetrafluoroethylene valved conduits were most frequently used (80.7%), whereas bovine jugular vein conduits (7.5%) and homografts (1.1%) were rarely employed. "Functional Durability and Performance" was the most prioritized criterion (median score: 4.00), with a median expected durability of 10 years. We concluded that in Japan, where a homograft supply system is not established, handmade expanded polytetrafluoroethylene conduits are the primary choice despite their off-label status. A significant gap exists between current performance of conduits in general and clinical expectations for durability, underscoring the need for technological advancements in conduit design.