HOMOGRAFTS FOR RIGHT-VENTRICULAR OUTFLOW TRACT RECONSTRUCTION IN CONGENITAL HEART-DISEASE

In 49 patients aged 2.2-34.8 (mean 11) years, homografts (20 aortic, 2 9 pulmonary) were implanted in the right ventricular outflow tract as an isolated procedure or part of corrective surgery for congenital hea rt disease: tetralogy of Fallot with pulmonary stenosis (23 cases), pu lmonary atresia with ventricular septal defect (10 cases) truncus arte riosus (8 cases) or transposition of the great arteries with pulmonary stenosis (8 cases). Previous palliative procedures had been performed on 34 patients, and 37 had undergone repair of right ventricular outf low tract, with one to four sternotomies prior to homograft implantati on. Homograft valve sizes ranged from 14 to 25 mm internal diameter. C oncomitant intra- or extracardiac procedures were performed in 29 case s. Follow-up was complete at a mean of 3 +/- 0.3 (0-8) years. Early an d total mortality was 2.0% (1/49), due to sepsis and multi-organ failu re unrelated to the homograft. At follow-up all but one of the patient s had an improved New York Heart Association function class. Eight pat ients (16.3%) with a mean age of 9.2 +/- 1.8 (2.8-15.5) years at impla ntation had homograft malfunction (stenosis in three, regurgitation in two and combined in three) at follow-up, averaging 4.1 +/- 1.0 (0.4-6 .9) years, with no significant difference between aorta and pulmonary homograft subsets. Freedom from structural valve deterioration was 46. 6 +/- 22% for pulmonary and 32.3 +/- 21.3% for aortic homografts at th e 7-year follow-up (difference not significant). In two patients an ao rtic homograft was uneventfully replaced. In conclusion, homograft imp lantation in patients with right ventricular outflow tract obstruction improves function class and can entail low mortality and morbidity, e ven after multiple previous median sternotomies.