Left atrial appendage insertion for right ventricular outflow tract reconstruction

Background. The left atrial appendage (LAA) may serve as an alternative to the pulmonary arterial wall for right ventricular outflow tract (RVOT) reco nstruction without an extracardiac conduit. Methods. Five consecutive patients with pulmonary atresia or severe stenosi s underwent corrective (n = 4) or palliative (n = 1) RVOT reconstruction us ing an LAA insertion. Surgery was performed to treat tetralogy of Fallot, d ouble-outlet right ventricle, or transposition of the great arteries. By in serting the LAA into the obstructed portion, the width of the posterior wal l of the RVOT was 20 mm or more. The anterior half of the RVOT was then aug mented with pericardial patch. Results. There were no early or late postoperative deaths, and no major com plications (arrhythmias, thrombo-embolic episodes, infective endocarditis, need for reoperation). The postrepair systolic right ventricularto-systemic arterial pressure ratio was 0.61 +/- 0.26. Color Doppler now mapping revea led that the reconstructed RVOT was nonobstructive and had nonturbulent now . No thrombus or pseudoneointimal formation was observed in the RVOT. Conclusions. LAA insertion in the RVOT is an effective alternative to, or a djunct of, direct anastomosis. It offers several advantages, including fewe r early and midterm complications and avoiding the use of an extracardiac c onduit. (C) 2001 by The Society of Thoracic Surgeons.