Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease

Background-Few studies have explored the long-term function of cryopreserve d homograft valves used for reconstruction of the right ventricular tract ( RVOT) in patients with congenital heart disease. Methods and Results-Among 205 patients receiving cryopreserved homografts f or reconstruction of the RVOT between November 1985 and April 1999, the out come of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median ape at implantation was 4.4 years (mean 6.9+/-7.6 years, range 3 days to 48 years). End points inc luded(1) patient survival, (2) homograft failure (valve explant or late dea th), and (3) homograft dysfunction (homograft insufficiency or homograft st enosis). Survival was 88% at 10 years, Freedom from homograft failure was 7 4+/-4% at 5 years and 54+/-7% at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z value <2, and previou s procedure as risk factors for homograft failure and dysfunction. Aortic h omograft type and extracardiac operative technique predicted homograft fail ure but not dysfunction. For patients <less than or equal to>1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z value <2 and aortic valve type predicted homograft valve failure. Conclusions-Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adverse ly affect graft longevity include younger age, longer donor warm ischemic t ime, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.