ORTHOTOPIC PULMONIC VALVE-REPLACEMENT WITH A PULMONARY HOMOGRAFT AS AN INTERPOSITION GRAFT

Pulmonary regurgitation (PR) following nonvalved reconstruction of the right ventricular outflow tract is usually well tolerated. However, a small percentage of patients develop progressive right ventricular di latation and failure due to long-standing PR. When this group of patie nts becomes refractory to medical management, pulmonic valve replaceme nt (PVR) may offer symptomatic relief and hemodynamic improvement. Fro m a cumulative experience, the pulmonary homograft may be the optimal choice for PVR due to its very low transvalvular gradient assuring opt imal hemodynamics, the absence of anticoagulation-related and thromboe mbolic complications, and the excellent mid-term results when compared to other valved conduit, including the aortic homograft. We report ou r experience in two patients who have been operated upon at the BWH be tween March and August 1995 for severe pulmonary valve insufficiency a nd right heart failure, who received cryopreserved pulmonary homograft s. We also describe our technique of PVR using a pulmonary homograft a s an orthotopic root replacement.