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Original Articles: Pediatric Cardiac

Midterm Results of Size-Reduced Cryopreserved Homografts for Right Ventricular Outflow Tract Reconstruction

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Accepted for publication March 1, 2010.

^_* Address correspondence to Dr Jun, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Ilwon-dong 50, Gangnam-gu, Seoul, 135-710, Korea (Email: tgjunsmc{at}gmail.com).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Size reduction of valved homografts has been investigated for right ventricular outflow tract reconstruction because of limited supply of small-sized grafts. However, follow-up results are lacking.

Methods: From 1997 to 2007, 45 patients underwent placement of 34 pulmonary and 11 aortic, size-reduced bicuspid homografts for right ventricle to pulmonary artery connection, which was part of a Rastelli-type operation (n = 35; 78%), redo right ventricular outflow tract reconstruction (n = 5; 11%), double-switch operation (n = 3; 7%), or palliative right ventricle to pulmonary artery connection (n = 2; 4%). Mean age at surgery was 20.0 ± 24.4 months. Twenty patients (44%) were younger than 1 year old. Mean body weight was 9.6 ± 7.1 kg. Diameter of the bicuspid conduit was 15.0 ± 1.5 mm (z value, 3.4 ± 1.9). Graft dysfunction was defined as pressure gradient greater than 50 mm Hg or moderate or greater regurgitation on follow-up echocardiography. Survival, freedom from graft explantation, and freedom from graft dysfunction were estimated by the Kaplan-Meier method. Risk factor for graft dysfunction was evaluated by multivariate analysis.

Results: There were 2 (4.4%) early deaths. During a mean follow-up of 49.4 ± 37.2 months, 13 patients showed graft dysfunction. Five of them had their grafts explanted. Freedom from graft explantation was 100% at 1 year after implantation, 97.4% ± 2.5% at 3 years, and 89.0% ± 6.2% at 5 years. Freedom from graft dysfunction was 92.4% ± 4.2% at 1 year, 78.8% ± 7.3% at 3 years, and 52.9% ± 10.9% at 5 years. Diagnosis of truncus arteriosus was identified as a factor for graft dysfunction (p = 0.028).

Conclusions: Size-reduced homografts may provide an alternative for right ventricular outflow tract reconstruction when an appropriately sized homograft is unavailable.

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