*3.3.2 Valved conduits*

Valved conduits used during the repair of a variety of congenital heart defects, most commonly tetralogy of Fallot with pulmonary atresia, truncus arteriosus, and Rastelli procedure for (corrected) transposition of the great arteries with pulmonary outflow tract obstruction. These conduits include homografts (aortic/ pulmonary/femoral vein), xenografts (bovine jugular vein), and synthetic (Dacron

### **Figure 2.**

*Intraoperative photos demonstrating the Ozaki technique for reconstruction of a new pulmonary valve using the autologous pericardium. (A) A large sheet of the anterior pericardium is harvested once the sternotomy is performed, (B) the pericardium is then mounted on the plate provided with the Ozaki set and is treated with glutaraldehyde 0.6% for 3 minutes, (C) the main pulmonary artery and the right ventricular outflow tract are opened longitudinally and remnants of the pulmonary valve leaflets are resected and the Ozaki sizers are used to determine the size of the future pericardial leaflets and to mark the suture lines and determine the location of the commissures, (D) the pericardial leaflets are marked using the Ozaki template, (E) the leaflets are cut with scissors, and (F) suturing is begun with running polypropylene along the marked lines in the right ventricular outflow tract. RV: right ventricle.*

### **Figure 3.**

*Intraoperative photos showing the rest of the steps for the Ozaki reconstruction of the pulmonary valve. (A) Pericardial leaflets are sewn in with running polypropylene sutures, and (B) two leaflets along the posterior native annulus and the anterior leaflet is sewn to the undersurface of the pericardial patch (asterisk) that is used to augment the right ventricular outflow tract and the main pulmonary artery. RV: right ventricle.*

conduit, expanded polytetrafluoroethylene [e-PTFE]). Several factors affect the choice of any of these valved conduits such as the age of the patient, the original pathology, previous procedure/conduit used, and availability.

### *3.3.3 Homografts*

Homografts continued to remain the most commonly used conduits for RVOT reconstruction. A variety of these homografts have been used including aortic, pulmonary (**Figure 4**), and more recently valved femoral veins. The advantages include its availability in smaller sizes and the lack of the rigidity associated with other prostheses, which make them suitable conduits for neonates, infants, and small children. Downsides include long-term calcifications, cost, and limited availability in many countries. We reserve the use of homografts for infants and small

### **Figure 4.**

*Intraoperative photo for a patient who underwent a Ross procedure with a pulmonary homograft used to establish the right ventricular-to-pulmonary arterial confluence continuity. RV: right ventricle, Ao: ascending aorta, PA: pulmonary artery homograft, RA: right atrium.*

children due to the absence of suitable size prostheses in this age and for those with endocarditis as well.
