The American Association for Thoracic Surgery (AATS) 2025 Expert Consensus Document: Management of Ebstein anomaly in children and adults
Presented During: Congenital Innovation Session: Hot Topics in Congenital Heart Surgery
Children's Healthcare of Atlanta
Atlanta, GA
United States - Contact Me
Paul Chai is Chief of Pediatric Cardiothoracic Surgery at Children's Healthcare of Atlanta/Emory University. He completed his general and cardiothoracic surgery residency at Duke University Medical Center, and his pediatric cardiothoracic surgical fellowship at Mott Children's Hosptial/University of Michigan.
Saturday, May 3, 2025: 4:45 PM - 5:00 PM
Seattle Convention Center | Summit
Room: Ballroom 2, Level 5
Description
Objective: This study aimed to compare the clinical outcomes of right ventricular outflow tract (RVOT) reconstruction using bovine jugular vein conduits and polytetrafluoroethylene (PTFE) valved conduits.
Methods: This study included patients who underwent RVOT reconstruction using bovine jugular vein conduits (Group C) and PTFE valved conduits (Group P) between 2013 and 2023. The median follow-up duration was 52.3 months. Conduit dysfunction was defined by either of the following two criteria: significant stenosis (flow velocity ≥ 3.5 m/sec), or significant regurgitation (≥ moderate). Excessive conduit dilation was defined as an increase in conduit diameter by more than 50% of its original size. Propensity score matching was performed using age, body weight, primary diagnosis, McGoon ratio, dual RVOT pathway, and conduit size as covariates. Kaplan-Meier estimates and the log-rank test were used to assess survival rates. Predictors of conduit dilation were determined using the Cox proportional hazards model.
Results: A total of 261 patients were included in the study (172 patients in Group C, 89 patients in Group P). Of these, 100 patients from Group C and 50 patients from Group P were matched using propensity score analysis. In the matched cohort, the median age and body weight at surgery were 9.9 months and 7.5 kg, respectively. The conduit sizes ranged from 12 to 18 mm. No significant differences were observed between Group C and Group P in 5-year overall survival (94.4% vs. 86.5%), conduit explantation-free survival (75.3% vs. 73.8%), or conduit dysfunction-free survival (51.5% vs. 44.3%) (Figure). In patients with smaller conduits (12 and 14 mm), the 5-year conduit stenosis-free survival rate was significantly lower in Group P (38.3% vs. 63.1%, P=0.027). Excessive conduit dilation was observed exclusively in Group C. On multivariable analysis, truncus arteriosus (HR 3.964; 95% CI, 1.553-10.123; P=0.004), the presence of MAPCA (HR 9.310; 95% CI, 3.671-23.611; P<0.001), and conduit size (HR 0.426; 95% CI, 0.289-.0629; P<0.001) were significant predictors of excessive conduit dilation.
Conclusions: The durability of small and medium-sized bovine jugular vein and PTFE valved conduits is comparable in RVOT reconstruction. Smaller PTFE valved conduits are associated with an increased probability of conduit stenosis. Bovine jugular vein conduits carry a risk of excessive dilation in patients with truncus arteriosus, MAPCA, and smaller conduits.
Methods: This study included patients who underwent RVOT reconstruction using bovine jugular vein conduits (Group C) and PTFE valved conduits (Group P) between 2013 and 2023. The median follow-up duration was 52.3 months. Conduit dysfunction was defined by either of the following two criteria: significant stenosis (flow velocity ≥ 3.5 m/sec), or significant regurgitation (≥ moderate). Excessive conduit dilation was defined as an increase in conduit diameter by more than 50% of its original size. Propensity score matching was performed using age, body weight, primary diagnosis, McGoon ratio, dual RVOT pathway, and conduit size as covariates. Kaplan-Meier estimates and the log-rank test were used to assess survival rates. Predictors of conduit dilation were determined using the Cox proportional hazards model.
Results: A total of 261 patients were included in the study (172 patients in Group C, 89 patients in Group P). Of these, 100 patients from Group C and 50 patients from Group P were matched using propensity score analysis. In the matched cohort, the median age and body weight at surgery were 9.9 months and 7.5 kg, respectively. The conduit sizes ranged from 12 to 18 mm. No significant differences were observed between Group C and Group P in 5-year overall survival (94.4% vs. 86.5%), conduit explantation-free survival (75.3% vs. 73.8%), or conduit dysfunction-free survival (51.5% vs. 44.3%) (Figure). In patients with smaller conduits (12 and 14 mm), the 5-year conduit stenosis-free survival rate was significantly lower in Group P (38.3% vs. 63.1%, P=0.027). Excessive conduit dilation was observed exclusively in Group C. On multivariable analysis, truncus arteriosus (HR 3.964; 95% CI, 1.553-10.123; P=0.004), the presence of MAPCA (HR 9.310; 95% CI, 3.671-23.611; P<0.001), and conduit size (HR 0.426; 95% CI, 0.289-.0629; P<0.001) were significant predictors of excessive conduit dilation.
Conclusions: The durability of small and medium-sized bovine jugular vein and PTFE valved conduits is comparable in RVOT reconstruction. Smaller PTFE valved conduits are associated with an increased probability of conduit stenosis. Bovine jugular vein conduits carry a risk of excessive dilation in patients with truncus arteriosus, MAPCA, and smaller conduits.
Presentation Duration
15 minute presentation
Other
Expert Consensus Document