Handmade Valved Woven Dacron Conduits as an Alternative for Repair of Congenital Heart Defects

Truncus arteriosus surgery has a mortality rate of 6.9 percent to 12 percent, with a long-term survival rate of 75 percent at 20 years. It is often performed alongside other cardiovascular repairs in neonates. Challenging cases involve valve insufficiency or coronary anomalies (1,2). Regardless of the conduit type used during the initial repair, a subsequent operation is necessary to replace it as the child grows older (3). 

Despite requiring reoperation, many patients live into adulthood with good outcomes. Primary repair of a common arterial trunk utilizing a handmade conduit can achieve remarkably low perioperative mortality rates and yield satisfactory early and mid-term outcomes, which can be favorably contrasted with outcomes reported when utilizing homografts (4-6). 

The Patient 

A 6-month-old female patient was referred to the center with a history of diaphoresis, fatigue, diastolic murmur grade II/ IV, low weight gain, and a previous diagnosis of truncus arteriosus (TA) type I, tetravalva trunk valve with severe regurgitation, persistent left superior vena cava (PLSVC) and ventricular septal defect (VSD), all confirmed by an echocardiogram. 

The Surgery 

The surgical approach for this patient was to perform a Rastelli procedure with a 14-millimeter Dacron conduit valved with CorMatrix as part of the TA repair. 

A total median sternotomy was performed. Total cardiopulmonary bypass (CPB) was established with tricaval canulation and occlusion of both pulmonary branches from the initiation of CPB until aortic cross-clamping and cardioplegia administration were completed. Myocardial protection was established by moderate hypothermia of 28°C and administration of Del Nido antegrade cardioplegia. 

Initially, the pulmonary artery buttons from the TA were dissected, aortoplasty was executed, and the truncus remained as the neoaorta. The right anterior ventriculotomy was executed, and the concomitant VSD was repaired. Finally, the previously configured conduit was anastomosed to the pulmonary buttons and the right ventricle to reestablish continuity. 

Conclusion 

The use of a handmade valve Dacron conduit is effective for the repair of congenital heart defects, as it facilitates diverse diameters and offers a lower economical cost compared to standard conduits such as homografts and xenografts.

References

1. Naimo PS, Konstantinov IE. Surgery for truncus arteriosus: Contemporary practice. Ann Thorac Surg. 2021;111(5):1442-50. doi:10.1016/j.athoracsur.2020.06.036.
2. Hamzah M, Othman H, Daphtary K, et al. Outcomes of truncus arteriosus repair and predictors of mortality. J Card Surg. 2020;35(8):1856-64. doi:10.1111/jocs.14730.
3. Boshnakov V, Mitev I, Lazarov S, et al. Right ventricular outflow tract reconstruction in truncus arteriosus: A 30-year two-center comparison between homografts and bovine jugular vein. Braz J Cardiovasc Surg. 2023;38(5) . doi:10.21470/1678-9741-2022-0341.
4. Curi-Curi P, Cervantes J, Soulé M, Erdmenger J, Calderón-Colmenero J, Ramírez S. Early and midterm results of an alternative procedure to homografts in primary repair of truncus arteriosus communis: Primary repair of truncus arteriosus communis. Congenit Heart Dis. 2010;5(3):262-70. doi:10.1111/j.1747-0803.2010.00410.x.
5. Ramírez-Marroquín S, Curi-Curi PJ, Calderón-Colmenero J, García-Montes JA, Cervantes-Salazar JL. Common arterial trunk repair by means of a handmade bovine pericardial-valved woven Dacron conduit. World J Pediatr Congenit Heart Surg. 2017;8(1):69-76. doi:10.1177/2150135116674439.
6. Boshnakov V, Mitev I, Lazarov S, et al. Right ventricular outflow tract reconstruction in truncus arteriosus: A 30-year two-center comparison between homografts and bovine jugular vein. Rev Bras Cir Cardiovasc. 2023;38(5). doi:10.21470/1678-9741-2022-0341.

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