Multidisciplinary approach and treatment options in right ventricular outflow tract malformations

BACKGROUND: Among patients with congenital heart disease, implantation of a valved conduit is common practice for surgical reconstruction of malformations involving the right ventricular outflow tract (RVOT). The conduit has limited durability, and treatments with surgical replacement and transcatheter pulmonary valve replacement (TPVR) are common. Previous studies indicate that TPVR, despite being a less invasive alternative, is not used for the majority of these patients. METHODS AND RESULTS: This is a descriptive study of the medical records of 100 consecutive adult patients with RVOT malformations who were evaluated a total of 118 times between January 1, 2008 and December 31, 2015, at meetings of the hospital’s multidisciplinary heart patient review board, in which relevant specialists make all treatment decisions on each case through a consensus process. The most common overall outcome decision was surgical conduit implantation. In 51 cases, the patient had a pre-existing conduit and, of those, 16 cases were recommended for TPVR. In seven of those 16, TPVR could not be performed, most commonly due to the risk of coronary compression or unfavorable conduit anatomy. CONCLUSION: Among patients with congenital heart disease involving the RVOT, surgical conduit implantation was the main treatment both in native RVOT malformations and in the case of a pre-existing dysfunctional conduit, despite the introduction of TPVR. Although the hospital’s multidisciplinary heart patient review board often recommended TPVR, it was found to be unfeasible in many cases. The main reasons were risk of coronary compression and unfavorable conduit anatomy.