Reoperative homograft right ventricular outflow tract reconstruction

Background. Homografts are implanted in the right ventricular outflow tract (RVOT) of children, with the knowledge that reoperation might be required. We reviewed 14 years of homograft RVOT reconstruction to assess the feasib ility of homograft replacement and to determine risk factors for homograft survival. Methods. From February 1985 through March 1999, 223 children (age 5 days to 16.9 years) underwent primary RVOT reconstruction with an aortic or pulmon ary homograft. Of these, 35 patients underwent homograft explant at the imp lanting hospital with insertion of a second homograft from 2 months to 13.3 years after the first implantation. The primary operation and reoperation patient groups were compared with regard to incidence of early death, late death, homograft-related intervention without explant, and homograft explan t. Results. Actuarial survival and event-free curves for initial and replaceme nt homografts were not significantly different. Univariable analysis was pe rformed for the following risk factors: weight (p < 0.0001), age (p < 0.003 ), homograft diameter (p < 0.0001), homograft type (p < 0.01), surgery date (not significant [NS]), gender (NS), Blood Group match (NS), and type of d istal anastomosis (NS). Multivariable analysis of significant univariable r isks revealed small homograft diameter to be a significant risk factor (p < 0.001) for replacement. Conclusions. The RVOT homografts eventually require replacement. Patient an d homograft survival for replacement homografts is similar to primary homog rafts. Reoperative homograft RVOT reconstruction is possible, with reasonab ly low morbidity and mortality. (C) 2001 by The Society of Thoracic Surgeon s.