Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction

Abstract

To determine late patient outcome and homograft durability, we reviewed 326 patients who received aortic (n = 230) or pulmonary (n = 118) cryopreserved homografts for right ventricular outflow reconstruction between January 1985 and October 1993. Patient survival, including operative mortality, 5 years after the operation was similar between the two groups (pulmonary homograft 86%, aortic homograft 80%; p = not significant by log-rank test). However, 5-year freedom from homograft failure was significantly better for pulmonary homografts (94% versus 70%, p < 0.01 by log-rank test). Late calcification was evaluated by chest roentgenography and echocardiography. Overall, 20% of aortic homografts became moderately or severely calcified compared with 4% of pulmonary homografts (p < 0.01). Twenty-six percent of aortic homografts in children 4 years old or younger had moderate or severe obstruction associated with calcification, whereas only 11% of aortic homografts in patients over 4 years of age had calcific obstruction (p < 0.01). No late deaths among patients receiving pulmonary homografts were related to graft failure; two late deaths in the aortic homograft group were homograft related. Risk factors for patient mortality and homograft failure (defined as either need for homograft replacement because of homograft failure or as homograft-related death) were identified by the Cox multivariate analysis. Aortic type of homograft was a significant risk factor for homograft failure (p < 0.0001), but type of homograft was not correlated with patient mortality. Age 4 years or younger was a significant risk factor for both mortality (p < 0.01) and homograft failure (p = 0.03) in aortic homograft recipients but not in pulmonary homograft recipients. These results indicate that both aortic and pulmonary homografts provided excellent intermediate-term patient survival after right ventricular outflow tract reconstruction, but pulmonary homografts are more durable than aortic homografts with less calcification and obstruction, especially among children 4 years old or younger.

Right Ventricle to Pulmonary Artery Reconstruction Using a Valved Homograft

“…12 Since then, several studies have shown an improvement in survival rates, ranging from 81% to 94% at 3 years after surgery. 20,21 The results from the present study showed a cumulative 22 In addition, Bull et al pointed out the following significant risk factors for death: numerous postoperative complications, severe associated anomalies, few operations before conduit repair, and previous BlalockHanlon procedure. 15 Multivariate analysis of the data from the present patients revealed 2 risk factors: homograft replacement and the use of ePTFE.…”

Disfunção do homoenxerto pulmonar utilizado na reconstrução do trato de saída do ventrículo direito

“…Forbess et al 19 , Bando et al 9 and Dearanie et al 4 found a higher failure rate of the homograft associated to the cardiopathies as truncus arteriosus, transposition of the great arteries with pulmonary stenosis and double exit pathway from the right ventricle; however, in this study, there was no homograft durability correlation with the type of cardiopathy.…”

“…The option of this service for the use of the pulmonary homograft, in such position, is based on studies that show that the aortic homograft in pulmonary position presents higher index of calcification due to its composition rich in elastin [4][5][6][7][8][9][10][11][12][13][14][15] .…”

“…In young people, the insertion of the homograft it is considered a risk factor for the conduit failure 4,5,8,9,12,14,15,[18][19][20][21] . The reasons for this are diverse and, among them, the accelerated growth pattern of the children, the use of homografts of smaller sizes and the immunological response exacerbate in the children.…”

Is the “porcellain homograft” a contraindication for transcatheter pulmonary valve implantation? A

“…Zmiany degeneracyjne zachodzą szybciej w homograftach aortalnych niż w płuc-nych, a procesy wapnienia są bardziej nasilone [8,9]. Podjęto próbę przeznaczyniowego wszczepienia zastawki płuc-nej u pacjenta z bardzo zwapniałym homograftem, który -patrząc na obraz radiologiczny oraz retrospektywnie po usunięciu operacyjnym -można nazwać analogicznie do porcelanowej aorty "porcelanowym" homograftem aortalnym.…”