Right Ventricular Outflow Tract Reconstruction in Truncus Arteriosus-With or Without a Conduit? A Systematic Review and Meta-Analysis.
Kristine Santos, Bezalel Hakkeem, Hellen Pereira et al.
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In 30 seconds
This systematic review and meta-analysis compared conduit-based (CB) with nonconduit-based (NCB) right ventricular outflow tract reconstruction during primary repair of truncus arteriosus. Seven studies included 360 patients, 174 of whom were neonates in the CB group. Early and long-term mortality did not differ significantly between approaches. CB reconstruction was associated with more RVOT reoperations (OR 3.70; 95% CI 2.02-6.76; P = .003) and a higher overall reintervention rate, including surgical and catheter-based procedures. The authors suggest NCB reconstruction may provide greater long-term durability.
Key findings
- Early mortality did not differ significantly between CB and NCB reconstruction (OR 0.61; 95% CI 0.13-2.92; P = .43).
- Long-term mortality did not differ significantly between approaches (OR 1.22; 95% CI 0.09-17.23; P = .83).
- RVOT reoperation was more frequent with CB reconstruction (OR 3.70; 95% CI 2.02-6.76; P = .003).
- Overall reintervention, including surgical and catheter-based procedures, was higher in the CB cohort (OR 2.45; 95% CI 1.33-4.52; P = .01).
Why it matters
Primary repair of truncus arteriosus requires establishing right ventricle-to-pulmonary artery continuity, and the choice of reconstruction may affect later procedures. The pooled findings indicate similar survival but more reintervention after conduit-based repair, highlighting durability as an important outcome alongside mortality when comparing surgical strategies.
What to keep in mind
The meta-analysis included seven studies and 360 patients; long-term mortality estimates showed substantial heterogeneity (I² = 78%).