Current status and priorities of valved conduits for right ventricle-to-pulmonary artery reconstruction in Japan: a nationwide survey

Abstract

Right ventricle-to-pulmonary artery reconstruction is essential in congenital heart surgery. In Japan, cryopreserved homograft availability is limited, necessitating alternative materials. This study systematically elucidated the status of right ventricle-to-pulmonary artery conduit use and surgeon priorities in Japan. In 2024, a web-based nationwide survey was conducted by the Japanese Society of Paediatric Cardiology and Cardiac Surgery, targeting 126 institutions. We analyzed data from 2021–2023 regarding primary diagnoses, conduit types, and selection criteria. Responses were obtained from 52 institutions (41.2%), covering 926 cases. Handmade expanded polytetrafluoroethylene valved conduits were most frequently used (80.7%), whereas bovine jugular vein conduits (7.5%) and homografts (1.1%) were rarely employed. “Functional Durability and Performance” was the most prioritized criterion (median score: 4.00), with a median expected durability of 10 years. We concluded that in Japan, where a homograft supply system is not established, handmade expanded polytetrafluoroethylene conduits are the primary choice despite their off-label status. A significant gap exists between current performance of conduits in general and clinical expectations for durability, underscoring the need for technological advancements in conduit design.