Ebstein anomaly is a rare congenital heart defect that is characterized by failure of the tricuspid valve leaflets to delaminate from the right ventricular endocardium, resulting in apical displacement of the tricuspid valve annulus and atrialization of the right ventricle. An irreparable tricuspid valve generally precludes at least initial attempts at a biventricular repair in a young infant. Although there are commercially available prosthetic tricuspid valves small enough to be implanted in these patients, they are generally not appropriate for young infants due to their bulk, which makes them prone to producing heart block. We present a case in which a bovine jugular vein conduit was suspended inside a ringed polytetrafluoroethylene graft and successfully used as a bioprosthetic option for tricuspid valve replacement in a 10-week-old, 4.4 kg infant with Ebstein anomaly of the tricuspid valve, which we could not repair.

Objective Late Fontan failure and attrition is an increasingly prevalent problem for which there is no primary therapy. A Fontan circulation is a circulation that lacks a subpulmonary pump. We are developing a technology that can safely and reliably restore subpulmonary pump function in a Fontan circulation to reverse the Fontan paradox and maintain normal circulatory health. Methods A rotary pump scaled for adolescent and adult use was developed for implantation to physiologically augment flow in the total cavopulmonary connection (TCPC). Design objectives include 30/70% SVC/IVC inflow draw over a broad range of performance, and no obstruction in the event of device failure. Hydrodynamic and hemodynamic performance were characterized in vitro in a Fontan mock circulatory loop using blood analog. Hemolysis was characterized in blood. Results The pump augments TCPC flow (SVC/IVC inflow; LPA/RPA outflow) at +6-10 mmHg, ranging to +18 mmHg at 3K RPM. Performance is consistent over a wide range of cardiac output. Power requirement is low (1W) at +6 mmHg pressure rise. Hemolysis is comparable to other commercially available pumps. Cavitation or suction was not observed. In the stalled condition (0 RPM), gradient is ≤1 mmHg. Conclusions A Fontan pump can safely reverse the Fontan paradox. Features include a fail-safe contingency that is clinically manageable. The technology may prevent progression of Fontan failure in the setting of preserved systemic ventricular systolic function. As a surgical strategy of long-term biventricular health maintenance, it may improve quality and duration of life for patients with single ventricle heart disease.

BackgroundSystemic artery-to-pulmonary artery (SA-PA) shunts provide effective palliation for complex congenital heart disease (CHD) but carry a risk for morbidity and mortality. We aimed to comprehensively analyze our experience with SA-PA shunts.MethodsOur institutional Society of Thoracic Surgeons (STS) database was queried to identify patients who underwent SA-PA shunts from 2009 to 2022, excluding those who underwent the Norwood procedure, right ventricle-PA shunt, or fenestrated patch. Definitions from the STS Congenital Heart Surgery Database Specifications were used. Shunt failure included dysfunction secondary to thrombosis, obstruction, stenosis, or outgrowth requiring intervention.ResultsA total of 287 patients met inclusion criteria. Shunts were placed at a median of 15.0 days (interquartile range 7.0-39.5). A thoracotomy approach was used in 178 out of 287 patients (62.0%), and cardiopulmonary bypass was employed in only 46 of 287 cases (16.0%). Survival to the next stage was 89.5% (246/275), with in-hospital mortality of 6.3% (18/287) and interstage mortality of 4.2% (12/287). Shunt failure occurred in 54/287 (18.8%), and 77/287 (26.8%) required reintervention for shunt-related complications. On multivariable analysis, poorer shunt failure-free survival was associated with any syndrome, left-sided arch vessel shunt origin, concurrent complex repairs, competitive flow from a patent ductus arteriosus, and delayed antiplatelet initiation. The thoracotomy approach was protective. Risk factors for worse survival to the next stage included shunt thrombosis and perioperative platelet transfusion.ConclusionsWhile complications remain common, our contemporary results demonstrate that SA-PA shunts remain a reliable palliation for CHD with insufficient pulmonary blood flow. Risk reduction may involve careful management of competitive pulmonary blood flow and prompt initiation of antiplatelet therapy.

BackgroundWe aim to elucidate the outcomes of patients who underwent a Ross II procedure at our institution.MethodsEight patients underwent a Ross II procedure at our institution between 2002 and 2008. Electronic medical records were queried to obtain demographic, procedural, and recent follow-up data.ResultsThe mean follow-up time for this cohort is 17 ± 6.2 years, and the pulmonary autograft has stayed in place, on average, for 9.6 ± 8.3 years. At last follow-up, the average pulmonary autograft mean gradient was 6.1 ± 2.4 mm Hg. No new mitral valve reoperations have been required since our last publication. Three early patients developed at least moderate pulmonary homograft (PH) regurgitation, although none of the patients in this cohort had significant PH stenosis at their last follow-up. None of the patients with a pulmonary homograft have required reintervention to date. There have been three deaths in this cohort, two of which were outlined in our previous study. More recently, Patient 2-who underwent a Ross II procedure to surgically correct rheumatic mitral valve stenosis and regurgitation-died 17 years after her operation due to complications of diabetic ketoacidosis.ConclusionTo our knowledge, this study represents the longest follow-up of a Ross II cohort ever reported, and the largest experience with the procedure in North America. The Ross II procedure offers a durable tissue alternative to conventional prosthetic valves for mitral valve replacement, particularly in younger patients, women of childbearing age, and those who have a contraindication to anticoagulation.

Continuous flow (CF) cavopulmonary assist devices (CPAD) are currently being developed as the substitute for absent subpulmonary power source in patients with univentricular Fontan circulation. CF-CPAD need to avoid vena caval suction, and autonomously change pump output to meet physiological demand. Ideally, CF-CPAD would also enhance pulmonary vascular pulsatility, which is diminished in patients with Fontan circulation. Pulsatility reduction was related to the endothelial dysfunction of the lungs, elevated pulmonary resistance, and arteriovenous malformations in the lung. A control algorithm was developed for CF-CPAD, which could predict cavopulmonary pressure head (CPPH) with a neural network (NN) model and increase pulmonary vascular pulsatility with a proportional-integral controller that switches between a high and a low CPPH setpoint. Input data of the NN model include CPAD current and speed, the output data is CPPH. The developed NN method was tested in-silico during rest, exercise, and increased vena caval resistance. Various conditions including 1) constant CF-CPAD speed control as baseline, 2) direct measurement of CPPH with pressure sensors, and 3) an extended Kalman Filter (EKF) to estimate CPPH were compared to the performance of this NN method. Results demonstrated that the baseline Fontan supported with CF-CPAD has diminished pulsatility. The proposed method provided physiologic perfusion, avoided vena caval suction, and augmented pulmonary pulsatility by up to similar to 10 mmHg, compared to similar to 6 mmHg with EKF method. The proposed NN control algorithm estimated CPPH faster and more accurately than the EKF control strategy, and had a similar performance when CPPH was directly measured.

Background: Given improved contemporary survival of adults with congenital heart disease (ACHD), we aimed to evaluate trends in ACHD surgery and outcomes at a single center over a 27-year period. Methods: Surgical databases were retrospectively queried for patients >18 years old who underwent ACHD surgery between January 1, 1994, and December 31, 2020. A total of 2,195 included patients underwent 2,425 cardiac surgical procedures within the specified time frame. Patients were grouped by era: I, 1994-2000; 2, 2001-2010; and 3, 2011-2020. Trends in primary cardiac diagnosis and surgical management were evaluated. Results: The median age increased across the eras. The most common primary cardiac diagnoses (n = 2,425) overall were left ventricular outflow tract anomalies (n = 2,019, 83%), atrial septal defect (n = 407, 17%), right ventricular outflow tract anomalies (n = 360, 15%), and ventricular septal defect (n = 110, 4.5%). The most commonly observed procedures overall were operations on the left ventricular outflow tract (n = 1,633, 67%), aorta (n = 675, 28%), coronary arteries (n = 449, 19%), right ventricular outflow tract (n = 323, 13%), and atrial septal defect (n = 264, 11%). Major complications occurred in 10% of cases, and 58 patients died within 30 days of their operation yielding an operative mortality of 2.4%. Conclusion: To our knowledge, this is the largest single center report on surgery for adults with congenital heart disease. Surgery for ACHD has been performed at our center with relatively low morbidity and mortality over the last few decades.

Ohio).So, my questions are, 1, you talk to us a lot about the cavopulmonary difference between normal and a Fontan is about 10.But most of your pumps or the different variations have always just tried to get 2. Why don't we try to normalize that gradient and go back to 10?Dr Mark Rodefeld (Indianapolis, Ind).So, the motorized pump that's in development can deliver 10 mm Hg pressure rise.I think it's not yet clear how much pressure exactly a person would tolerate or would be ideal, but that pump can generate up to even 20, 25, 30 mm Hg if necessary.I think the sweet spot for full cavopulmonary assist is probably in the þ7 mm Hg range in a generally healthy patient.This self-powered pump is never going to perform at that level.This pump

Objective: After Fontan palliation, patients with single-ventricle physiology are committed to chronic circulatory inefficiency for the duration of their lives. This is due in large part to the lack of a subpulmonary ventricle. A low-pressure rise cavopulmonary assist device can address the subpulmonary deficit and offset the Fontan paradox. We investigated the feasibility of a Fontan pump that is self-powered by tapping reserve pressure energy in the systemic arterial circulation. Methods: A double-inlet, double-outlet rotary pump was designed to augment Fontan flow through the total cavopulmonary connection. Pump power is supplied by a systemic arterial shunt and radial turbine, with a closed-loop shunt return to the common atrium (QP:QS 1:1). Computational fluid dynamic analysis and lumped parameter modeling of pump impact on the Fontan circulation was performed. Results: Findings indicate that a pump that can augment all 4 limbs of total cavopulmonary connection flow (superior vena cava/inferior vena cava inflow; left pulmonary artery/right pulmonary artery outflow) using a systemic arterial shunt powered turbine at a predicted cavopulmonary pressure rise of +2.5 mm Hg. Systemic shunt flow is 1.43 lumped parameter model, 22% cardiac output. Systemic venous pressure is reduced by 1.4 mm Hg with improved ventricular preload and cardiac output. Conclusions: It may be possible to tap reserve pressure energy in the systemic circulation to improve Fontan circulatory efficiency. Further studies are warranted to optimize, fabricate, and test pump designs for hydraulic performance and hemocompatibility. Potential benefits of an autonomous Fontan pump include durable physiologic shift toward biventricular health, freedom from external power, autoregulating function and exercise responsiveness, and improved quality and duration of life.

Patients with single ventricle defects undergoing the Fontan procedure eventually face Fontan failure. Long-term cavopulmonary assist devices using rotary pump technologies are currently being developed as a subpulmonary power source to prevent and treat Fontan failure. Low hydraulic resistance is a critical safety requirement in the event of pump failure (0 RPM) as a modest 2 mmHg cavopulmonary pressure drop can compromise patient hemodynamics. The goal of this study is therefore to assess the passive performance of a viscous impeller pump (VIP) we are developing for Fontan patients, and validate flow simulations against in-vitro data. Two different blade heights (1.09 mm vs 1.62 mm) and a blank housing model were tested using a mock circulatory loop (MCL) with cardiac output ranging from 3 to 11 L/min. Three-dimensional flow simulations were performed and compared against MCL data. In-silico and MCL results demonstrated a pressure drop of < 2 mmHg at a cardiac output of 7 L/min for both blade heights. There was good agreement between simulation and MCL results for pressure loss (mean difference − 0.23 mmHg 95% CI [0.24–0.71]). Compared to the blank housing model, low wall shear stress area and oscillatory shear index on the pump surface were low, and mean washout times were within 2 s. This study demonstrated the low resistance characteristic of current VIP designs in the failed condition that results in clinically acceptable minimal pressure loss without increased washout time as compared to a blank housing model under normal cardiac output in Fontan patients.

Head-flow HQ curves for a Fontan cavopulmonary assist device (CPAD) were measured using a blood surrogate in a mock circulatory loop and simulated with various computational fluid dynamics (CFD) models. The tests benchmarked the CFD tools for further enhancement of the CPAD design. Recommended Reynolds-Averaged Navier-Stokes (RANS) CFD approaches for the development of conventional ventricular assist devices (VAD) were found to have shortcomings when applied to the Fontan CPAD, which is designed to neutralize off-condition obstruction risks that could contribute to a major adverse event. The no-obstruction condition is achieved with a von Karman pump, utilizing large clearances and small blade heights, which challenge conventional VAD RANS-based CFD hemodynamic simulations. High-fidelity large eddy simulation (LES) is always recommended; however, this may be cost-inhibitive for optimization studies in commercial settings, thus the reliance on RANS models. This study compares head and power predictions of various RANS turbulence models, employing experimental measurements and LES results as a basis for comparison. The models include standard k-epsilon, re-normalization group k-epsilon, realizable k-epsilon, shear stress transport (SST) k-omega, SST with transitional turbulence, and Generalized k-omega. For the pressure head predictions, it was observed that the standard k-epsilon model provided far better agreement with experiment. For the rotor torque, k-epsilon predictions were 30% lower than LES, while the SST and LES torque values were near identical. For the Fontan CPAD, the findings support using LES for the final design simulations, k-epsilon model for head and general flow simulation, and SST for power, shear stress, hemolysis, and thrombogenicity predictions.

Objective: Cavopulmonary assist devices (CPAD) are being developed to treat failing Fontan circulation. The control algorithm to provide appropriate levels of CPAD support using cavopulmonary pressure head (CPPH) has been proposed. However, the controller estimated CPPH using Golay-Savitzky (GS) filter and extended Kalman filter (EKF), which has high computation complexity. In this study, a new model for accurately predicting CPPH for CPAD using neural network was proposed. Methods: The proposed neural network model has structure of 2-15-15-1. Inputs of the neural network model are intrinsic CPAD parameters and output is CPPH with varying physiological conditions for Fontan patients. Back-propagation algorithm with Adam training function and Tanh-Sigmoid activation function were applied in the proposed model. Efficacy and robustness of the proposed neural network model for predicting CPPH was tested with (1) CPPH without noise, (2) CPPH with 10% uniformly distributed noise, and (3) CPPH estimated with GS filter and EKF. Results and Conclusion: The proposed neural network model predicted required CPPH more accurately than using GS filter and EKF regardless of different physiologic test conditions. Significance: The proposed neural network model can quickly find the optimized solution to predict CPPH, and may be more easily applied to CPADs for providing physiological perfusion.

Background: Fontan failure patients with diastolic dysfunction with elevated systemic venous pressures, and systolic dysfunction with elevated ventricular end-diastolic pressures, are at a high risk of morbidity. These patients will require cavopulmonary support that replaces the subpulmonary power source to treat diastolic dysfunction and a left ventricular assist device (LVAD) to unload the native ventricle to treat systolic dysfunction. A physiologic control algorithm is needed to autonomously maintain systemic and pulmonary circulation balance at different clinical conditions. Methods: Mathematical models of a cavopulmonary assist device (CPAD) was developed from mock circulation data. CPAD and LVAD models were coupled to the Fontan failure circulatory system model. Proportional integral (PI) controllers were used to maintain a constant cavopulmonary pressure head (CPPH) of 5-8 mmHg for the CPAD and 75-80 mmHg for the pump pressure head across the LVAD. The control algorithm was tested for rest, exercise, transitions from rest to exercise, and rapid increases in systemic vascular (SVR) and pulmonary vascular resistances (PVR). Results and conclusions: The control algorithm maintained adequate perfusion by autonomously adjusting the pump speed during rest and exercise conditions. Steady state ventricular end diastolic pressures were <10 mmHg indicating adequate systemic unloading of the native ventricle even with CPAD support. Vena caval and ventricular suction were not observed during transitions from exercise to rest and rapid increases in SVR and PVR. These results demonstrate the feasibility of a physiologic control algorithm to maintain systemic and pulmonary circulation balance in failing Fontan patients.

Background: Fontan failure is emerging as an intractable problem for which current therapy is only palliative. We report a chronic cavopulmonary assist device that has potential to normalize the Fontan circulation long-term to preempt Fontan-associated disease progression as biventricular health maintenance. Methods: A Fontan viscous impeller pump based on an outrunner brushless DC motor was fabricated and tested using impeller vane heights of 1.09 mm or 1.62 mm (Fig 1). The pump is integrated within a housing as the total cavopulmonary connection (TCPC). Mock circuit and numerical studies assessed hydraulic performance, stopped impeller blockage, and shear stress distributions. Results: In-vitro study demonstrated a desirable 11 mm Hg pressure head rise at 2400 RPM at 5 L/min with the 1.62 mm vane height; the 1.09 mm vane performance was similar at 3000 RPM (Fig 2). Either vane achieved a relatively flat HQ curve as needed to meet physiological needs over a living range of metabolic activity. Impeller blockage at 0 RPM was <0.5 mmHg pressure drop compared to a simple blank TCPC housing, a desirable fail-safe result (Fig. 2). The numerical model predicted hydraulic performance in reasonable agreement to the in vitro studies with adequate washing in the primary and secondary flow paths and allowing for a design tool for flow and stress study. Conclusion: A single impeller Fontan pump provided adequate performance with the potential for minimal venous pathway obstruction. The pump is being developed for long-term implant providing biventricular maintenance. Figure 1. Prototype pump in TCPC housing Figure 2. Hydraulic performance

Objective: The timing and nature of and risk factors for reoperation after the arterial switch operation in the setting of d-transposition of the great arteries requires further elucidation. Methods: A total of 403 patients who underwent arterial switch operation from 1986 to 2017 were reviewed. Institutional preference was for pulmonary artery reconstruction using a pantaloon patch of fresh autologous pericardium. The targets for coronary artery reimplantation were identified by intermittent root distension. Multivariable analysis was used to identify risk factors for reoperation. Results: Median follow-up was 8.6 years (interquartile range [IQR]: 2-16.9). Pulmonary arterioplasty was the most common reoperation (n = 11, 2.7%) at 3.3 years (IQR: 1.4-11.4) postoperatively. Subvalvar right ventricular outflow tract reconstruction (RVOTR) was required in nine (2.2%) patients at 2.5 years (IQR: 1.1-5.3) postoperatively. Aortic valve repair or replacement (AVR/r) was required in seven (1.7%) patients at 13.6 years (IQR: 10.0-15.8) postoperatively. Aortic root replacement (ARR) and Coronary Artery Bypass Graft/coronary patch arterioplasty were required in five (1.2%) patients each at 13.6 years (IQR: 11.0-15.3) and 11.3 years (IQR: 2.3-13.6) postoperatively, respectively. Taussig-Bing anomaly was a risk factor for any reoperation (P = .034). Risk factors for specific reoperations included ventricular septal defect for AVR/r (P = .038), Taussig-Bing anomaly for RVOTR (P = .004), and pulmonary artery banding for ARR (P = .028). Conclusions: Pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension during coronary reimplantation have minimized respective outflow tract reoperations. Certain anatomic subsets carry different risks for late reoperation, and pulmonary artery and/or RVOT reinterventions tend to occur sooner than aortic reinterventions. Special attention to these higher risk subpopulations will be critical to optimizing lifelong outcomes.

Background. The stentless porcine aortic root prosthesis (SPAR) has been described as a suitable valve for right ventricular outflow tract reconstruction (RVOTR). Indiana University Methodist Hospital in Indianapolis, Indiana began using this valve for RVOTR in 1998. This study reports medium-term to late- term outcomes of the valve in the pulmonary position. Methods. A retrospective chart review was conducted of patients older than 18 years of age who underwent RVOTR with a SPAR between April 2000 and October 2019. Primary outcomes included survival and freedom from any valvular reintervention. Secondary outcomes included endocarditis and conduit dysfunction detected by routine echocardiography or cardiac magnetic resonance imaging. Results. A total of 135 patients underwent RVOTR with a SPAR at a median age of 32.4 years (range, 18 to 71 years). Of these patients, 129 had previous surgery. Indications included pulmonary insufficiency (90.4%), stenosis (34.8%), endocarditis (7.4%), and carcinoid (4.4%). Median follow-up was 2.97 years (interquartile range, 0.6 to 8.0 years). Overall survival was 93.3%, with 3 perioperative death and 6 late deaths. Endocarditis developed in 4 patients (2.9%), 2 of whom required reoperation. Progressive conduit degradation was evident at 10 years, with 22.2% and 7.7% having moderate stenosis and insufficiency, respectively. Eight (5.9%) reinterventions included 2 surgical replacements, 3 percutaneous replacements, and 3 balloon valvuloplasties at means of 8.5, 7.4, and 2.2 years, respectively. Overall freedom from reintervention at 1, 5, and 10 years was 99.1%, 94.7% and 90.7%, respectively. Conclusions. In this large, single-institution experience with a long follow-up period, use of the SPAR demonstrated excellent midterm to long-term durability, low rates of endocarditis, and high freedom from reintervention. (C) 2021 by The Society of Thoracic Surgeons

Objective: Fontan failure can be potentially addressed with an implantable pump in the cavopulmonary junction (cavopulmonary assist device, CPAD) to replace the missing subpulmonary power source. Fontan pulmonary circulation lacks pulsatility due to the absence of the right ventricle, which has adverse physiological consequences. CPAD can augment pulmonary flow and improve Fontan hemodynamics. However, CPAD operating at a constant pump speed does not provide pulmonary arterial pulsatility, provide physiologic flow to match cardiac demand, or avoid suction. To overcome these limitations, a sensorless control strategy for CPAD is proposed. Methods: CPAD pump speed measurement, an intrinsic pump parameter, was used to estimate cavopulmonary pressure head (CPPH). A gain scheduled proportional-integral controller alternates CPPH between high/low setpoints (CPPHHr/CPPHLr) that generates pulsatility, while simultaneously adapting to cardiac demand and avoiding suction. Computer simulations were performed to quantify the overall performance of the proposed algorithm at rest and exercise, rapid transition from exercise to rest, and doubling of the vena caval resistance. The performance was compared against CPPH measured using pressure sensors, and a constant pump speed control strategy. Results: The sensorless algorithm generated a pulmonary vascular pulsatility of approximately 10 mmHg, and matched the cardiac demand at rest and exercise. The frequency of pump speed modulation was 10-15 cycles per minute and no suction was observed. Conclusion and significance: The sensorless strategy outperformed constant CPAD speed control algorithm for improvement of pulmonary vascular pulsatility and physiologic perfusion. Further validation is needed using mock loop and animal tests.

Objective: Mechanical circulatory support devices using continuous flow blood pump technologies are currently being developed to provide cavopulmonary support in patients with Fontan circulation. While cavopulmonary support can functionally replace the missing native right ventricle and biventricularize the Fontan circulation, there is a need for the pump to adapt to variable physiologic demands. A constant pump speed limits the ability to provide sufficient physiologic perfusion over a range of physiologic conditions. To address this challenge, a physiologic control algorithm for a Fontan pump was developed. Methods: The proposed algorithm uses a gain-scheduled, proportional-integral controller that generates a user defined cavopulmonary pressure head (CPPH = pulmonary artery pressure - vena caval pressure), to provide physiologic pressure rise while avoiding suction. The approach uses only intrinsic pump parameters and does not require the use of pressure or flow sensors. Performance and robustness of the sensorless control algorithm was quantified in-silico by simulating the following conditions: (1) Directly measured CPPH with pressure sensors; (2) CPPH estimation using the intrinsic pump measurement of pump speed and extended Kalman filter (EKF); (3) constant speed control algorithm; and (4) rapid four-fold increase in vena caval resistance (VCR) for (1) to (3). Results: The results demonstrated that the sensorless control algorithm maintained physiologic perfusion while simultaneously preventing vena caval suction without the need for pressure sensors. Conclusion and significance: The proposed algorithm was superior to the constant speed control strategy for physiologic perfusion and suction prevention, and warranted further investigation in vitro and in-vivo.

Background. Multiple conduits for right ventricular outflow tract reconstruction exist, although the ideal conduit that maximizes outcomes remains controversial. We evaluated long-term outcomes and compared conduits for right ventricular outflow tract reconstruction in children with truncus arteriosus. Methods. Records of patients who underwent truncus arteriosus repair at our institution between 1981 and 2018 were retrospectively reviewed. Primary outcomes included survival and freedom from catheter reintervention or reoperation. Secondary analyses evaluated the effect of comorbidity, operation era, conduit type, and conduit size. Results. One hundred patients met inclusion criteria. Median follow-up time was 15.6 years (interquartile range, 5.3-22.2). Actuarial survival at 30 days, 5 years, 10 years, and 15 years was 85%, 72%, 72%, and 68%, respectively. Early mortality was associated with concomitant interrupted aortic arch (hazard ratio, 5.4; 95% confidence interval, 1.7-17.4; P = .005). Median time to surgical reoperation was 4.6 years (interquartile range, 2.9-6.8; n = 58). Right ventricle to pulmonary artery continuity was established with an aortic homograft (n = 14), pulmonary homograft (n = 41), or bovine jugular vein conduit (n = 36) in most cases. Multivariate analysis revealed longer freedom from reoperation with the bovine jugular vein conduit compared with the aortic homograft (hazard ratio, 3.1; 95% confidence interval, 1.3-7.7; P = .02) with no difference compared with the pulmonary homograft. Larger conduit size was associated with longer freedom from reoperation (hazard ratio, 0.7; 95% confidence interval, 0.6-0.9; P <.001). Conclusions. The bovine jugular vein conduit is a favorable conduit for right ventricular outflow tract reconstruction in patients with truncus arteriosus. Concomitant interrupted aortic arch is a risk factor for early mortality. (C) 2020 by The Society of Thoracic Surgeons.