Truncus Arteriosus Repair With Modified Barbero Marcial Technique With Reconstruction of Neo-Pulmonary Valve With RAA

This video demonstrates a surgical technique for repairing truncus arteriosus type 1. The procedure is a modification of the Barbero-Marcial technique (1) and utilizes the right atrial appendage (RAA) to reconstruct the neo-pulmonary valve. This approach aims to address the challenges of postoperative pulmonary regurgitation and promotes long-term growth (2), particularly in resource-limited settings where access to homografts may be limited. Additionally, using bovine conduits can carry risks for short- and long-term complications.  

Procedure 

The procedure began with a right ventriculotomy, followed by closure of the ventricular septal defect (VSD) using a pericardial patch. The truncal root was then separated into the aorta and pulmonary artery. Next, the right atrial appendage (RAA) was harvested and shaped into a neo-pulmonary valve, which was subsequently anastomosed to the right ventricle and pulmonary artery. A pericardial patch was then used to reinforce the ventricular outflow tract. 

Key Considerations 

There are a few key considerations in this technique: 

1. The RAA should be at least 1 cm in length and have a quadrangular shape. 

2. The posterior wall of the pulmonary-to-right ventricle pathway should be at least half the expected circumference of the pulmonary annulus. 

Potential Benefits 

This approach offers several potential benefits, including a reduced risk of postoperative pulmonary regurgitation, the potential for long-term growth, and a reduced reliance on donor tissues or synthetic grafts. This technique can be safely applied to both Type A1 and Type A2 truncus arteriosus. By using the RAA as an autologous graft, this technique offers a promising approach for truncus arteriosus repair, especially in regions with limited access to traditional graft materials. 

References

1. Barbero-Marcial M, Riso A, Atik E, Jatene A. A technique for correction of truncus arteriosus types I and II without extracardiac conduits. J Thorac Cardiovasc Surg. 1990 Feb;99(2):364-9. PMID: 2299877.
2. Amirghofran A, Edraki F, Edraki M, Ajami G, Amoozgar H, Mohammadi H, Emaminia A, Ghasemzadeh B, Borzuee M, Peiravian F, Kheirandish Z, Mehdizadegan N, Sabri M, Cheriki S, Arabi H. Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short- to mid-term results. Eur J Cardiothorac Surg. 2021 Apr 13;59(3):697-704. doi: 10.1093/ejcts/ezaa374. PMID: 33164039.

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