Uses of homograft conduits for right ventricle to pulmonary artery connections in the neonatal period.

A significant number of congenital heart defects share the common characteristic that surgical interventions to either "repair" or palliate these defects generally require the use of nonautologous conduits to substitute for an absent right ventricle to pulmonary artery connection. Tetralogy of Fallot with pulmonary atresia, truncus arteriosus, transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, and certain forms of double-outlet right ventricle are among the defects in which these conduits are used to create a pathway from the right ventricle to the pulmonary arteries. Such a conduit should ideally have growth potential, be nonthrombogenic, and function indefinitely. No such conduit has yet been devised, although efforts continue to be made with "tissue engineering" techniques to develop a conduit with one or more of these characteristics. In addition, when these conduits are used in the neonate, other characteristics including stiffness, conduit bulk, ease of passing sutures, and porosity are critically important to the success of a neonatal repair. We have found homografts to be the conduits which currently best fulfill the physical and handling requirements for neonatal applications in patients with defects in which autologous vascular tissue cannot easily make up for an absent right ventricle to pulmonary artery connection. The current discussion is therefore focused on the use of homograft conduits interposed between the right ventricle and pulmonary artery as part of neonatal reparative operations.