Bicuspidized Pulmonary Homograft for Truncus Arteriosus Repair

Abstract

Primary repair is preferable to palliation in infants with truncus arteriosus. At our institute, an appropriately small homograft valved conduit is not available for every patient; a bicuspidized pulmonary valve homograft is an alternative. Between December 1996 and August 2005, 24 patients aged 28 days to 21 months with truncus arteriosus underwent primary repair with a homograft valved conduit; bicuspidized homografts were used in 15 of them. In the 18 (75%) patients who survived to hospital discharge, 5-year survival was 94% (75% for tricuspid homografts and 100% for bicuspidized homografts, which was not significantly different). Freedom from reoperation or balloon angioplasty in all 18 survivors was 89% at 5 years. Freedom from reoperation in tricuspid and bicuspidized homograft groups at 5 years was 67% and 100%, respectively; the difference was not statistically significant. Bicuspidized homografts worked as well as tricuspid conduits in the intermediate term. The remodeled homografts showed excellent hemodynamic characteristics and appear to be a reasonable alternative when an appropriate size of valved homograft is unavailable.

Long-term follow-up after primary complete repair of common arterial trunk with homograft: A 40-year experience

“…This is broadly in agreement with other studies, which have demonstrated similar early mortality rates, with the majority of deaths occurring in the early postoperative period. 14,16,19 The actuarial survival in our study was 83.1% AE 6.6% at 30 years, indicating that the majority of patients with CAT survive long term. Similar but less efficacious results have been reported in the literature, with one study demonstrating an 83% actuarial survival at 15 years postoperatively.…”

“…Twenty-four (75%) were neonates. The homograft used in the right ventricular outflow tract was aortic in 24 patients and pulmonary in 8 patients (mean diameter, 15.8 AE 3.5 mm; median diameter, 16 mm [range,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)). The median follow-up was 24.5 years (range, 5.6 months to 43.5 years).Results: There were 3 hospital deaths and 1 late death.…”

Long-term outcome of right ventricular outflow tract reconstruction with bicuspidalized homografts

“…Given the shortage of small-sized conduits for these reconstructions in young infants, more readily available larger-sized grafts can be used after size reduction by bicuspidalization [2,3]. The long-term functionality of bicuspidalized grafts in the RV outflow tract (RVOT) has been described by few groups [4][5][6][7]. The results in children with Ross or extended Ross (Konno) procedures have only been reported anecdotally [4,7].…”

Long-term course after pediatric right ventricular outflow tract reconstruction

“…3 , 4 However, some studies have reported limited availability and poor durability of the allografts. 5 , 6 Moreover, the supply of small-sized homografts is also limited. 5 The Contegra conduit, a commercial integrated valved conduit derived from heterogenous bovine jugular vein, was developed as an alternative option.…”

“…5 , 6 Moreover, the supply of small-sized homografts is also limited. 5 The Contegra conduit, a commercial integrated valved conduit derived from heterogenous bovine jugular vein, was developed as an alternative option. 7 Early and midterm results of RVOT reconstruction with homografts were good, but only a few studies have reported late outcomes, and there are no available reports from Thailand.…”