Evolution of pulmonary artery reconstruction techniques: a focus on the neovalve from the right atrial appendage

Introduction:
Pulmonary artery (PA) repair in pediatric cardiac surgery often utilizes the transannular patch (TAP) technique, which, while effective, is associated with complications such as right ventricular (RV) dysfunction and pulmonary valve (PV) regurgitation.

Aim:
Recent findings highlight the need for improved strategies to address these issues and enhance long-term outcomes.

Material and methods:
This retrospective cohort study analyzed 16 pediatric patients who underwent PA repair between December 2023 and April 2024. Patients were divided into two groups: right atrial appendage (RAA) neovalve (n = 8) and TAP (n = 8). Key procedural metrics, RV function, and postoperative outcomes were evaluated using standard statistical methods.

Results:
The RAA neovalve group demonstrated significantly reduced severe PV regurgitation compared to the TAP group (p < 0.001). Additionally, the RAA neovalve group exhibited improved RV function, with more patients showing no RV dysfunction (p = 0.014). The RAA neovalve group also experienced shorter ICU stays (3.88 ±0.84 days vs. 6.13 ±2.75 days, p = 0.044) and hospital stays (10.1 ±1.25 days vs. 13.2 ±3.19 days, p = 0.029).

Conclusions:
The RAA neovalve technique presents a significant improvement over traditional TAP in reducing severe PV regurgitation and enhancing RV function. The shorter ICU and hospital stays associated with the RAA neovalve suggest better postoperative recovery. These results indicate that the RAA neovalve could be a superior alternative to TAP for PA repair, warranting further research to confirm these benefits and explore long-term outcomes.