The outcome of antibiotic sterilised aortic homografts used in the Fontan procedure

Abstract

Between 1977 and 1988, 27 patients between the ages of 4 and 22 years (mean 8.9) underwent a Fontan procedure with the use of an antibiotic sterilised aortic homograft. There were 15 patients with tricuspid atresia, 9 with univentricular heart and 3 others. The homograft was anastomosed to a right-sided pulmonary artery in ten, to a left-sided main pulmonary artery in eight and in nine patients the homograft connected the right atrium to the right ventricle. There were five early deaths (18.5%) unrelated to the homograft and two late deaths at 7 and 10 years postoperatively. Five patients have required removal of the calcified obstructed homograft with no death. In three patients patches were inserted, but in two patients with good right ventricles a second homograft was inserted. In three of the re-operated patients the homograft lay directly behind the sternum and the femoral artery was exposed and in two of them the femoral artery was cannulated before the chest was opened to control haemorrhage. Of the patients 74% are alive up to 15 years later, 15 with their original homograft. Eight (57%) of those still have their original homograft more than 10 years post-operatively.

Aortic Arch Homograft Reconstruction of Nonconfluent Pulmonary Arteries During Extracardiac Fontan

“…Kiraly et al and Monro et al previously summarized the fate of aortic homografts in the Fontan circulation. 7,8 In their report, of 27 consecutive cases, freedom from reoperation was 100%, 88%, and 54% at 5, 10, and 15 years, respectively. Despite heavy calcification of the conduits, except for one patient, no hemodynamically significant gradients were found.…”

Double-barreled conduit for right atrioventricular connection in tricuspid atresia: A new technique

“…The upper incompressible pig valve prevents compression of the inferior homograft, and ideally, there should be longterm patency. Sternal compression, which has been the cause of homograft narrowing previously, 2,5 should not affect these valves. The importance of the creation of the largest possible communication in the Fontan circulation, irrespective of the type of connection used, has been well emphasized.…”

“…They calcify and narrow, necessitating surgical reinterventions for their removal, replacement, or both, whereas their occult obstruction can be the cause of unexpected death. 2 Apart from the process of calcification, direct pressure exerted on the homografts by the overlying sternum contributes to their obstruction. 2,5 The technique described here attempts to address these issues.…”

“…2 Apart from the process of calcification, direct pressure exerted on the homografts by the overlying sternum contributes to their obstruction. 2,5 The technique described here attempts to address these issues. Placing two conduits side by side in a double-barreled manner doubles the cross-sectional area and improves hemodynamics.…”

Tissue Engineering of Vascular Grafts: A Case Report From Bench to Bedside and Back

“…Synthetic grafts are used more commonly than biological conduits due to the high incidence of ectopic calcification in biological vascular conduits in the first few years after implantation. 21 Synthetic options include polytetrafluoroethylene grafts or polyethylene terephthalate grafts. polytetrafluoroethylene grafts have supplanted the use of polyethylene terephthalate and represent the current standard of care given the high incidence of stenosis due to neointimal hyperplasia associated with polyethylene terephthalate grafts.…”