Is Reconstructing the Right Ventricle-Pulmonary Artery Continuity Without a Conduit Worthwhile? Reevaluation in the Modern Era

Background: This retrospective study assessed the feasibility of our right ventricle-pulmonary artery reconstruction technique without a conduit. Methods: This technique consists of a connection of the pulmonary artery to the right ventricular incision for the posterior wall of the new route established exclusively using autologous tissue, and a transannular patch using a glutaraldehyde-treated autologous pericardium as the anterior wall incorporating a monocusp as pulmonary valve substitute using an extended polytetrafluoroethylene membrane. Results: From November 2007 to June 2024, 21 consecutive patients (median age, 15.2 months; median body weight, 8.7 kg) underwent this technique after 32 preparatory palliations in 20 patients. The diameter of the new route was less than 12 mm in 76% of patients. The left atrial appendage was interposed in the posterior wall in 15 patients (71.4%). There was 1 death due to fulminant pneumonia during the follow-up period (median, 5 years; maximum, 16.5 years). Eight patients required catheter balloon dilation after a median of 1.4 years postoperatively, with estimated free rates of initial catheter intervention of 57.4% and 38.2% after 5 and 10 years, respectively. Catheter intervention failed in 2 patients with immobile restrictive monocusps that were replaced with a new cusp after 2.5 years or a bioprosthetic valve after 15.6 years postoperatively. The estimated 5-year free reoperation rate was 92.9%. Conclusions: This technique could provide a reasonable alternative to the use of a small-diameter conduit, even in the modern era.