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Eur J Cardiothorac Surg 2007;32:133-142. doi:10.1016/j.ejcts.2007.02.025
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

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

^a Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
^b Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
^c Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

Received 23 October 2006; received in revised form 20 February 2007; accepted 23 February 2007.

^_* Corresponding author. Address: Hannover Medical School, Department of Pediatric Cardiology and Intensive Care Medicine, Carl-Neuberg-Str.1, K 10, D-30625 Hannover, Germany. Tel.: +49 511 532 9424; fax: +49 511 532 9832. (Email: boethig.dietmar{at}mh-hannover.de).

Objective: Homografts are considered the gold standard for right ventricular outflow tract reconstruction. Their long-term durability is limited, and alternatives became available. We evaluate their long-term hemodynamic performance to permit comparisons with alternative devices. Methods: Between 1985 and 2004, 188 homografts were implanted in pulmonary position at our institution. Mean patient age was 24.8 years (range 2 days–75 years); 56 were female and 132 male. Total follow-up time was 1073 years. Fifty-eight percent were Ross procedures (mean age 31.5 years) and 42% were different procedures (mean age 15.6 years); main diagnoses were tetralogy of Fallot (48%), truncus arteriosus (14%), transposition of the great arteries (11%). Twenty-six percent were redo implantations. We evaluated freedom from death, explantation, insufficiency, relevant gradient, degeneration, and the interval between diagnosis of degeneration and therapeutic procedure (therapeutic gap). Results were stratified by indication, age, history, homograft size, and origin. Results: Ten-year-freedom-from explantation was 82% in homografts >19 mm and 45% in smaller ones. Ten-year freedom from degeneration was 68% after Ross procedure and 25% after other operations; it was 83% in patients older than 10 years at implantation and 51% in younger ones. ‘Non-Ross-procedure’ and ‘implantation age below 10 years’ were the only independent risk factors for degeneration. The observed trend towards therapeutical gap reduction was not statistically significant. Conclusions: Homograft implantation in the pulmonary position can be performed with good long-term freedom from explantation. However, freedom from degeneration is a matter of concern. Therefore, alternative valved conduits are required especially for pediatric patients.

Key Words: Right ventricular outflow tract • Valved conduit • Homograft • Hemodynamic performance • Long-term follow-up