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Eur J Cardiothorac Surg 2005;28:211-216
© 2005 Elsevier Science NL

Original articles

Factors influencing the survival of cryopreserved homografts. The second homograft performs as well as the first

Bart Meyns ^{a , *} , Ramadan Jashari ^b , Marc Gewillig ^c , Luc Mertens ^c , Arnot Komárek ^d , Emmanuel Lesaffre ^d , Werner Budts ^e , Willem Daenen ^a

^a Department of Cardiac Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
^b European Homograft Bank, Brussels, Belgium
^c Department of Pediatric Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
^d Biostatistical Centre, Catholic University, Leuven, Belgium
^e Department of Cardiology, Catholic University, Leuven, Belgium

Received 23 September 2004; received in revised form 28 February 2005; accepted 30 March 2005.

^* Corresponding author. Tel.: +32 1 634 4260; fax: +32 1 643 4616. (Email: bart.meyns{at}uz.kuleuven.ac.be).

Abstract

Objective: To determine the life span of cryopreserved homografts implanted in the right ventricular outflow tract and the factors influencing it. Methods: From 1989 through 2003, we reconstructed the pulmonary valve with 301 homografts in 272 patients (median age 13 years; range 4 days–69 years). Indications were tetralogy of Fallot (136), truncus (23), Rastelli repair (11), double outlet ventricle (13), endocarditis (5), and the Ross operation (84). Median follow-up was 5.7 years (range 0–14). We analyzed possible predictors of graft replacement by simple and multiple Cox regression. Results: Actuarial survival was 96±1.2% at 1, 95±1.4% at 5, and 94±1.5% at 10 years follow-up. Three homografts were explanted because of endocarditis (excluded from the analysis). Freedom from explantation was 99.6±0.4% at 1, 94.5±1.7% at 5, and 81.8±4.1% at 10 years. Variables, significantly related to explantation in the univariate analysis, were younger age, small graft size, implantation in a non-anatomical position, the aortic donor homograft, a shorter aortic cross-clamp time and the implantation of a second homograft. In the multiple model, non-anatomical position (P=0.001), smaller graft size (P<0.0001) or younger age (on square root scale, P<0.0001) and clamp time (P=0.01) remain as independent risk factors. Immunological variables, like blood group incompatibility, implantation of a second homograft and short warm ischemic time were not significant. Conclusions: The life span of a cryopreserved homograft is determined by graft size (correlates with age) and the non-anatomic position (correlates with indication). In a specific patient, the second homograft performs as well as the first.

Key Words: Congenital heart surgery • Biological heart valve • Allograft

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