OUTCOME OF PULMONARY AND AORTIC HOMOGRAFTS FOR RIGHT-VENTRICULAR OUTFLOW TRACT RECONSTRUCTION

To determine late patient outcome and homograft durability, we reviewe d 326 patients who received aortic (n = 230) or pulmonary (n = 118) cr yopreserved homografts for right ventricular outflow reconstruction be tween January 1985 and October 1993. Patient survival, including opera tive mortality, 5 years after the operation was similar between the tw o groups (pulmonary homograft 86%, aortic homograft 80%; p = not signi ficant by log-rank test). However, 5-year freedom from homograft failu re was significantly better for pulmonary homografts (94% versus 70%, p < 0.01 by log-rank test). Late calcification was evaluated by chest roentgenography and echocardiography. Overall, 20% of aortic homograft s became moderately or severely calcified compared with 4% of pulmonar y homografts (p < 0.01). Twenty-six percent of aortic homografts in ch ildren 4 years old or younger had moderate or severe obstruction assoc iated with calcification, whereas only 11% of aortic homografts in pat ients over 4 years of age had calcific obstruction (p < 0.01). No late deaths among patients receiving pulmonary homografts were related to graft failure; two late deaths in the aortic homograft group were homo graft related. Risk factors for patient mortality and homograft failur e (defined as either need for homograft replacement because of homogra ft failure or as homograft-related death) were identified by the Cox m ultivariate analysis. Aortic type of homograft was a significant risk factor for homograft failure (p < 0.0001), but type of homograft was n ot correlated with patient mortality. Age 4 years or younger was a sig nificant risk factor for both mortality (p < 0.01) and homograft failu re (p = 0.03) in aortic homograft recipients but not in pulmonary homo graft recipients. These results indicate that both aortic and pulmonar y homografts provided excellent intermediate-term patient survival aft er right ventricular outflow tract reconstruction, but pulmonary homog rafts are more durable than aortic homografts with less calcification and obstruction, especially among children 4 years old or younger.