Right Ventricle to Pulmonary Artery Reconstruction Using a Valved Homograft

Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years☆☆☆

“…LeBlanc et al [10] stratified the freedom from explantation by patient age and found 89% free at 4 years for patients above 2 years of age at implantation versus 52% for the younger ones. Tatebe et al [11] found 42% freedom from homograft failure after 5 years in his observation of 141 homografts in patients under 10 years. Feier et al [12] reports a 30% incidence of mean transconduit gradient of 20 mmHg and more at 5 years; Böhm et al [13] found 66% freedom from explantation or transvalvular gradient of 30 mmHg or more after the same time, Settepani et al [14] communicates that 25.5% of his patients developed homograft stenoses (no time related estimate was given) and Williams et al [15] reports 88% freedom from reoperation at 5 years.…”

Ross Procedure for Aortic Insufficiency Due to Doubly Committed Subarterial Ventricular Septal Defect in Adults

“…A large polyester vascular prosthesis was used to reduce the risk of intimal proliferation, which can lead to conduit failure. The use of ePTFE on the RV–PA conduit is controversial 5 . The long‐term results of such conduits remain unknown, and careful follow‐up is required.…”

Results of balloon dilatation of stenotic homografts in pulmonary position in children and young adults

“…Although the short-term results are excellent, the longevity of the homograft remains a problem, mostly because of the development of stenosis time. 3,4 The optimal approach to this problem is still unclear. 5,6 Currently, there are several treatment options, such as balloon valvuloplasty, stenting of the homograft, percutaneous pulmonary valvular implantation, and surgical valve replacement.…”

“…Balloon dilatation has been used to dilate the stenosed homograft, but it is unclear whether this catheter intervention influences the longevity of the homograft significantly. 3 The reported series of homograft valvuloplasty are small, ranging from only 3 to a maximum of 12 patients. The results are not favourable: one study describes that catheter intervention did not prolong the longevity of the homograft; 3 two others report that they have abandoned this technique after unfavourable results.…”