Cryopreserved homografts in the pulmonary position: Determinants of durability

Background. The cryopreserved homograft has emerged as the pulmonary condui t of choice for the repair of many congenital heart defects. It is also use d for pulmonary valve replacement in the Ross procedure. Because of a wide range of patient ages and diagnoses, the risk of homograft failure may vary . Methods. We reviewed 185 consecutive pulmonary position implants performed between September 1985 and January 1999. We examined three age groups: pati ents less than 1 year of age (n = 53), patients 1 to 10 years of age (n = 4 6), and patients more than 10 years of age (n = 86). Results. Five-year Kaplan-Meier homograft survival was 25%, 61%, and 81% fo r the groups, respectively (p < 0.02). Smaller homograft size, younger pati ent age, and truncus arteriosus were risk factors for homograft failure in univariate analysis (p < 0.05). Smaller homograft size was the only predict or for homograft failure in multivariate analysis (p < 0.001). Twenty of 99 implants in patients less than 10 years old underwent transcatheter interv ention. The 3-year Kaplan-Meier implant survival of this group (79%) was no t different from those who did not undergo intervention (77%, p = 0.84). Su rvival of aortic and pulmonary homografts in patients less than 10 years of age was not different (p = 0.35). Ross procedure implants appear to have o ptimal survival (94%) at 5 years. Non-Ross implants in patients more than 1 0 years of age have 76% 5-year Kaplan-Meier survival, which is not differen t from Ross patients (p = 0.33). Conclusions. Small homografts have limited durability. Aortic homografts pe rform as well as pulmonary homografts in young patients. Once patients rece ive an "adult-size" homograft, at approximately 10 years of age, risk for i mplant failure approximates that of patients undergoing the Ross procedure. Transcatheter interventions, when indicated, may prolong homograft life. ( Ann Thorac Surg 2001;71:54-60) (C) 2001 by The Society of Thoracic Surgeons .