Direct Anastomosis Versus Conduit Repair for Right Ventricular Outflow Tract Reconstruction in Common Arterial Trunk: A Meta-Analysis of Reconstructed Time-to-Event Data

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OBJECTIVES: Repair of common arterial trunk (CAT) involves establishing the right ventricular outflow tract (RVOT) using either a conduit or a direct right ventricle-pulmonary artery (RVPA) anastomosis (DA). Conduits offer a valved pathway but are limited by durability and availability. The comparative outcomes of these 2 techniques remain uncertain. This work assessed whether DA improves survival, reduces complications and reintervention outcomes compared to conduit repair. METHODS: PubMed, Web of Science, EMBASE, and Cochrane Central were searched for studies comparing conduit versus DA for RVOT reconstruction from February 20, 2025 to March 30 30, 2025. The primary outcome was early mortality; secondary outcomes included haemodynamics, recovery, and complications. Time-to-event data were reconstructed from Kaplan-Meier curves. Pooled hazard ratios (HRs), risk ratios (RRs), or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. RESULTS: Eleven studies (767 patients; 419 conduit, 348 DA) were included. Early mortality (RR = 0.61, 95% CI, 0.26-1.44, P = .220) and long-term survival (HR = 1.11, 95% CI, 0.61-2.02, P = .738) were similar. Reoperation was more frequent in the conduit group (HR = 1.77, 95% CI, 1.05-3.01, P = .034). Conduit repair required longer ventilation (MD = 3.44 days, P = .010) and hospitalization (MD = 4.77 days, P = .030), with comparable ICU stay and RVOT growth. Truncal valve insufficiency (RR = 0.13, P = .130 for truncal valve vs conduit) was similar in incidence following DA. CONCLUSIONS: Conduit and DA repairs yield similar survival and postoperative complications in CAT, while DA offers fewer reoperations and faster recovery. Data from future prospective multicentre trials will support decision-making.

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