ATS August 2009: Zachariah et al.  Right Ventricle to Pulmonary Artery Conduit Augmentation Compared With Replacement in Young Children.  Ann Thor Surg, 2009; 88:574-580. 

In the August 2009 Annals, Zachariah et al from Boston have presented data regarding conduits in the pulmonary circulation.  Although there have been countless detailed analyses of this subject over the past 20 years, the current group maintain that the interpretation of prior reports is difficult due to heterogeneity of the population and other reasons. They purport to clarify the subject and add data regarding conduit augmentation rather than replacement, an approach similar in principle to that proposed by Cerfolio et al (Mayo Clinic) some years ago. The current report is quite interesting, although also difficult to interpret since the data are all retrospective and the indications arbitrary.  Nonetheless it is a very useful report.  

Patients included children younger than 10 years of age undergoing a first conduit reoperation (n = 180), involving either conduit replacement (n = 147) or conduit augmentation (n = 33).  There were no differences between the two groups with respect to age, size, or hemodynamic variables. Overall, early mortality was 0.5%, and 10-year survival was 95%. Freedom from reoperation was 80% at 5 years and 39% at 10 years, whereas freedom from reintervention (reoperation or catheter intervention) was 55% at 5 years and 26% at 10 years, with no differences between groups. As in other reports, undersized conduits were associated with shorter freedom from reoperation and both smaller BSA and undersized conduits were associated with shorter freedom from reintervention.  The authors concluded that conduit augmentation offers similar clinical outcomes in selected patients.  There are some obvious implications for morbidity and cost reduction.  Have the authors demonstrated that pulmonary insufficiency will not be a clinical problem as it is in other settings? 

Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/88/2/574 and add your own comments in the Dilemmas in Pediatric Cardiac Surgery discussion forum.