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Eur J Cardiothorac Surg 2000;17:140-145
© 2000 Elsevier Science NL

Are pulmonary homografts which were subjected to pulmonary hypertension more appropriate for aortic valve replacement than normal pulmonary homografts? A long-term multicentric echography study

^a European Homograft Bank, International Association, Military Hospital, rue Bruyn, B-1120 Brussels, Belgium
^b Department of Cardiac Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
^c Department of Cardiothoracic Surgery, Thoraxcentrum IZB, Galdereseweg 21, NL-4236 AE Breda, The Netherlands
^d Hildendorfweg 29, D-22587 Hamburg, Germany

Corresponding author. Tel.: +32-2-26440-66; fax: +32-2-268-51-71
e-mail: jasharir{at}hotmail.com

Objective: To compare long-term results of the European Homograft Bank (LHB) cryopreserved pulmonary homograft in left ventricular outflow tract (LVOT) subjected to pulmonary hypertension with those subjected to normal pulmonary pressure. The mid-term study of this material published in 1997 showed different results. Methods: Ninety EHB cryopreserved PHG were used for LVOT reconstruction in different European centres between May 1989 and December 1995. PHGs were classified in two groups: (1) Pulmonary hypertension PHG (procured from recipients of heart/heart-long transplantation) and (2) Normal pulmonary pressure PHG (procured from multiorgan donors and cadavers). Significant echocardiography changes were defined as a stenosis with gradient of more than 30 mmHg and/or insufficiency of >2+. Statistical analysis is calculated by the Kaplan–Meier survival curves, while differences in prevalence by the Log-Rank test. Results: Follow-up (FU) was available in 69 cases (76.7%): 46 in group 1 and 23 in group 2. Five patients have been excluded from the study because of early homograft explantation (technical problems or early valve incompetence). Fourteen out of 43 cases of group 1 (32.6%) and seven out of 21 cases of group 2 (33.3%) have been explanted after 2.5–88 months and 7–88 months, respectively. Significant echography changes have been found in 19 of 43 (44.18%) of group 1 and 11 of 21 cases (52.38%) of group 2 during the follow-up. Histology showed essentially wear and tear induced lesions. Mean FU was 36.9 (range, 6–88) and 41.3 months (range, 4–88) for group 1 and 2, respectively. No significant difference in the long-term outcome have been found between the two groups (P=0.38). Conclusion: Contrary to our previous echocardiography study of mid-term implants the long-term follow up of the PHGs implanted in the LVOT did not show better function of the pulmonary homografts subjected to pulmonary hypertension than those with normal pulmonary pressure. The high failure rate of the PHGs should discourage their use for LVOT reconstruction. Further echocardiography studies of remaining PHGs implanted in the LVOT, and gross and microscopic explant studies are required to judge on the definitive outcome of these grafts.

Key Words: Pulmonary homograft • Aortic valve replacement • Echocardiography

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