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Autologous Right Atrial Appendage Reconstruction For Pulmonary Valve Replacement: Early Hemodynamic Outcomes In An Infant Series
Srujan Ganta, MD, Howaida El-Said, MD, PhD, John J Nigro, MD.
Rady Childrens Hospital, San Diego, CA, USA.

Objective(s):
Competent pulmonary valve reconstruction during infant RVOT enlargement remains challenging due to limited conduit durability and lack of growth potential. Autologous right atrial appendage (RAA) tissue has been described as a neo-pulmonary valve with encouraging early results, but experience remains limited and largely confined to tetralogy of Fallot.
Methods:
We retrospectively reviewed 5 infants who underwent RVOT reconstruction using autologous RAA tissue fashioned as a pulmonary valve for tetralogy of Fallot (TOF) or double outlet right ventricle (DORV). Operative data and preoperative, intraoperative, and follow-up peak RVOT gradients and pulmonary insufficiency (PI) were analyzed.
Results:
Median age at surgery was 48 days (17-223) with operative weight 4.73 kg (3.1-6.7)(Figure 1A). There was no operative mortality or ECMO requirement. Preoperative peak RVOT gradient (n=3) was 88 mmHg (78-105). Intraoperative transesophageal echocardiography demonstrated a median peak RVOT gradient of 14 mmHg (10-17.4) with none to mild PI in all patients. At early follow-up (median 0.43 months, 0.07-10.4), peak RVOT gradient remained 15 mmHg (0-34) (Figure 1B); PI was none or trivial in 3 patients and mild in 2. No RVOT or valve-related reinterventions occurred.
Conclusions:
Autologous RAA-based pulmonary valve reconstruction yields favorable early hemodynamics with low gradients and minimal insufficiency across varied congenital pathologies, offering a promising autologous alternative to conduit-based RVOT reconstruction; longer-term follow-up is needed to assess durability.

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