Neopulmonary Valve Reconstruction Using Autologous Right Atrial Appendage: Early Single-Center Results

Abstract

Introduction: Right ventricular outflow tract (RVOT) reconstruction in congenital heart diseases such as tetralogy of Fallot (TOF) often requires a transannular patch, which can lead to postoperative pulmonary regurgitation (PR). Persistent PR may result in significant complications, including right ventricular (RV) dysfunction, arrhythmias, and the need for reintervention. The use of autologous right atrial appendage (RAA) tissue to create a functional neovalve has emerged as a promising alternative. Methods: Twelve pediatric patients who underwent RVOT reconstruction with an RAA neovalve between July 2023 and March 2025 were retrospectively evaluated. Demographic, surgical, and echocardiographic data were analyzed to assess early clinical outcomes. Results: The median age at surgery was eight months (IQR: 6-11), with a median weight of 7.1 kg (range: 5.7-16). Primary diagnoses included TOF (n = 9), TOF with pulmonary atresia (n = 2), and absent pulmonary valve (n = 1). No in-hospital mortality occurred. Predischarge echocardiography showed no or trivial PR in eight patients and mild PR in four patients. At a mean follow-up of 12.8 months, all patients exhibited either no or mild PR, and RV function remained normal. No patient required reintervention. Conclusion: Neovalve reconstruction using autologous RAA tissue is a safe, feasible, and hemodynamically effective technique for RVOT repair in selected pediatric patients. Due to its autologous nature, growth potential, and favorable early outcomes, it offers a meaningful alternative to synthetic or allogenic materials. Further follow-up studies are necessary to evaluate its long-term durability.