Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective
Objective: Severe right ventricular outflow tract obstruction in tetralogy of Fallot and variants necessitates the use of transannular patch in a significant proportion of children undergoing repair. We have used a Contegra monocusp together with delamination of native leaflet tissue in order to cre...
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Elsevier
2023-06-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723001128 |
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| author | Luigi Di Pasquale, MD Olivia Jaeger, MD Tugba Erdil, MD Martin Christmann, MD Daniel Quandt, MD Robert Cesnjevar, MD Hitendu Dave, MD |
| author_facet | Luigi Di Pasquale, MD Olivia Jaeger, MD Tugba Erdil, MD Martin Christmann, MD Daniel Quandt, MD Robert Cesnjevar, MD Hitendu Dave, MD |
| author_sort | Luigi Di Pasquale, MD |
| collection | DOAJ |
| description | Objective: Severe right ventricular outflow tract obstruction in tetralogy of Fallot and variants necessitates the use of transannular patch in a significant proportion of children undergoing repair. We have used a Contegra monocusp together with delamination of native leaflet tissue in order to create a functioning pulmonary valve. Methods: In total, 18 (2017-2022) consecutive Contegra monocusp implantations were included. Median age and weight were 3.65 [2.00; 9.43] months and 6.12 [4.30; 8.22] kg, respectively. Nine of 18 patients had undergone palliation. Native pulmonary leaflet tissue was recruited to create a single posterior cusp. Contegra monocusp selection was based on the goal to achieve a neoannulus of Z value ≈ 0. Monocusp sizes implanted were 16 [14; 18] mm. Patch plasty of left pulmonary artery (LPA) (9), right pulmonary artery (RPA) (2), and both LPA-RPA (5) were often performed. Results: All patients survived the operation and were discharged home in good health. Median ventilation time and hospital stay were 2 [1; 9] and 12.5 [9; 54] days, respectively. Follow-up duration was 30.68 [3.47; 60.47] months and 100% complete. One patient with well-corrected right ventricular outflow tract died 9.4 months postoperatively, possibly of aspiration. One child with membranous pulmonary atresia needed reoperation (conduit insertion) at 3.5 months of follow-up. Five needed catheter interventions: supravalvar stent (2), LPA stent (3), and RPA stent (1), most of them in the earlier half of the experience. Pulmonary annulus changed from preoperative –3.91 [–5.98; –2.23] to –0.10 [–1.44; 1.92] at discharge; growing proportionally to –0.13 [–3.52; 2.73] at follow-up. Kaplan–Meier freedom from composite dysfunction was 79.25 (95% confidence interval, +13.68%, –31.44%) at 36 months. Conclusions: Recruitment of native leaflets, optimal Contegra monocusp, and commissuroplasty provide an easily replicable technique for achieving a competent, proportionally growing neopulmonary valve. Longer follow-up is needed to determine its impact on delaying a pulmonary valve replacement. Video Abstract: |
| format | Article |
| id | doaj-art-e9636c5b7073423d9e3a168adc7e76bd |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-e9636c5b7073423d9e3a168adc7e76bd2025-08-20T03:38:26ZengElsevierJTCVS Techniques2666-25072023-06-011910911810.1016/j.xjtc.2023.03.013Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspectiveLuigi Di Pasquale, MD0Olivia Jaeger, MD1Tugba Erdil, MD2Martin Christmann, MD3Daniel Quandt, MD4Robert Cesnjevar, MD5Hitendu Dave, MD6Division of Congenital Cardiovascular Surgery, Pediatric Heart Centre & Children's Research Centre, University Children’s Hospital Zürich, Zürich, SwitzerlandDivision of Congenital Cardiovascular Surgery, Pediatric Heart Centre & Children's Research Centre, University Children’s Hospital Zürich, Zürich, SwitzerlandDivision of Congenital Cardiovascular Surgery, Pediatric Heart Centre & Children's Research Centre, University Children’s Hospital Zürich, Zürich, SwitzerlandDivision of Pediatric Cardiology, Kinderspital Luzern, Luzern, SwitzerlandDivision of Cardiology, Pediatric Heart Centre & Children's Research Centre, University Children’s Hospital Zürich, Zürich, SwitzerlandDivision of Congenital Cardiovascular Surgery, Pediatric Heart Centre & Children's Research Centre, University Children’s Hospital Zürich, Zürich, SwitzerlandDivision of Congenital Cardiovascular Surgery, Pediatric Heart Centre & Children's Research Centre, University Children’s Hospital Zürich, Zürich, Switzerland; Address for reprints: Hitendu Dave, MD, Division of Congenital Cardiovascular Surgery, Pediatric Heart Centre & Children’s Research Centre, University Children’s Hospital, University of Zürich, Steinwiesstrasse 75, 8032 Zürich, Switzerland.Objective: Severe right ventricular outflow tract obstruction in tetralogy of Fallot and variants necessitates the use of transannular patch in a significant proportion of children undergoing repair. We have used a Contegra monocusp together with delamination of native leaflet tissue in order to create a functioning pulmonary valve. Methods: In total, 18 (2017-2022) consecutive Contegra monocusp implantations were included. Median age and weight were 3.65 [2.00; 9.43] months and 6.12 [4.30; 8.22] kg, respectively. Nine of 18 patients had undergone palliation. Native pulmonary leaflet tissue was recruited to create a single posterior cusp. Contegra monocusp selection was based on the goal to achieve a neoannulus of Z value ≈ 0. Monocusp sizes implanted were 16 [14; 18] mm. Patch plasty of left pulmonary artery (LPA) (9), right pulmonary artery (RPA) (2), and both LPA-RPA (5) were often performed. Results: All patients survived the operation and were discharged home in good health. Median ventilation time and hospital stay were 2 [1; 9] and 12.5 [9; 54] days, respectively. Follow-up duration was 30.68 [3.47; 60.47] months and 100% complete. One patient with well-corrected right ventricular outflow tract died 9.4 months postoperatively, possibly of aspiration. One child with membranous pulmonary atresia needed reoperation (conduit insertion) at 3.5 months of follow-up. Five needed catheter interventions: supravalvar stent (2), LPA stent (3), and RPA stent (1), most of them in the earlier half of the experience. Pulmonary annulus changed from preoperative –3.91 [–5.98; –2.23] to –0.10 [–1.44; 1.92] at discharge; growing proportionally to –0.13 [–3.52; 2.73] at follow-up. Kaplan–Meier freedom from composite dysfunction was 79.25 (95% confidence interval, +13.68%, –31.44%) at 36 months. Conclusions: Recruitment of native leaflets, optimal Contegra monocusp, and commissuroplasty provide an easily replicable technique for achieving a competent, proportionally growing neopulmonary valve. Longer follow-up is needed to determine its impact on delaying a pulmonary valve replacement. Video Abstract: http://www.sciencedirect.com/science/article/pii/S2666250723001128tetralogy of FallotRVOTtransannular patchmonocuspContegra monocusppulmonary valve reconstruction |
| spellingShingle | Luigi Di Pasquale, MD Olivia Jaeger, MD Tugba Erdil, MD Martin Christmann, MD Daniel Quandt, MD Robert Cesnjevar, MD Hitendu Dave, MD Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective JTCVS Techniques tetralogy of Fallot RVOT transannular patch monocusp Contegra monocusp pulmonary valve reconstruction |
| title | Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective |
| title_full | Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective |
| title_fullStr | Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective |
| title_full_unstemmed | Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective |
| title_short | Transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructionCentral MessagePerspective |
| title_sort | transannular bovine jugular vein monocusp for the reconstruction of severe right ventricular outflow tract obstructioncentral messageperspective |
| topic | tetralogy of Fallot RVOT transannular patch monocusp Contegra monocusp pulmonary valve reconstruction |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723001128 |
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