Key result
Monocusp outflow patch shows no significant benefit over conduit for 12-year RVOT reoperation after adjustment.
Why the study?
Does monocusp valve outflow patch reconstruction reduce RVOT-related reoperation and improve long-term right ventricular function compared to conduit placement in patients with pulmonary atresia with ventricular septal defect?
Cohort (n=130)
Does monocusp valve outflow patch reconstruction reduce RVOT-related reoperation and improve long-term right ventricular function compared to conduit placement in patients with pulmonary atresia with ventricular septal defect?
In patients with PA/VSD, monocusp valve outflow patch reconstruction showed higher unadjusted 12-year freedom from reoperation than conduit placement (particularly in those without MAPCAs) and comparable school-age RV function on MRI, though the overall reoperation difference was not statistically significant after adjusting for surgical era.
Answers are grounded in this paper and cite their sources.
Comparable reoperation rates with MVOP versus conduits; leaves open optimal RVOT strategy for PA/VSD.
OBJECTIVE: This study evaluated reoperation and long-term right ventricular (RV) function after RV outflow tract (RVOT) reconstruction in pulmonary atresia with ventricular septal defect (PA/VSD), comparing monocusp valve outflow patch (MVOP) and conduit placement. METHODS: This retrospective review included 130 patients with PA/VSD who underwent MVOP with 0.1-mm expanded polytetrafluoroethylene (n=84) or conduit placement (n=46) between 1993 and 2025. The primary endpoint was RVOT-related reoperation; the secondary endpoint was long-term RV function measured by magnetic resonance imaging (MRI). RESULTS: Median age at repair was higher with MVOP group (2.4 vs. 1.4 years, P=.001), and median follow-up was 11.9 years. Freedom from RVOT-related reoperation at 12 years was higher with MVOP (78.0% vs. 60.2%, P=.017). In a sensitivity analysis additionally adjusting for surgical era, the association between reconstruction type and reoperation was attenuated and no longer statistically significant (adjusted hazard ratio for conduit vs MVOP, 1.79; 95% confidence interval, 0.72-4.43; P=.208). Subgroup analysis showed greater freedom from reoperation with MVOP in patients without major aortopulmonary collateral arteries (82.9% vs. 59.1%, P=.005). Cardiac MRI at school age showed comparable RV volumes and function between groups (all P >.05). CONCLUSIONS: MVOP demonstrated higher observed freedom from RVOT-related reoperation than conduit placement, although this association was attenuated after adjustment for surgical era, with comparable long-term RV function at school age. Surgical strategy should be individualized based on patient characteristics and RVOT anatomy.
No takes yet. Share an insight, caveat, or question.
Kimura et al. (2026) conducted a cohort in Pulmonary atresia with ventricular septal defect (PA/VSD) (n=130). Monocusp valve outflow patch (MVOP) with 0.1-mm expanded polytetrafluoroethylene vs. Conduit placement was evaluated on Freedom from right ventricular outflow tract (RVOT)-related reoperation at 12 years (HR 1.79, 95% CI 0.72-4.43, p=.017). Monocusp valve outflow patch had higher 12-year freedom from RVOT reoperation vs conduit (78.0% vs 60.2%, P=.017), though attenuated after era adjustment (aHR 1.79, 95% CI 0.72-4.43; P=.208).
Synapse has enriched 10 related papers. Consider them for comparative context: