Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction

Ko Bando, Gordon K. Danielson, Hartzell V. Schaff, Douglas D. Mair, Paul R. Julsrud, Francisco J. Puga

Research output: Contribution to journalArticlepeer-review

166 Scopus citations

Abstract

To determine late patient outcome and homograft durability, we reviewed 326 patients who received aortic ( n = 230) or pulmonary ( n = 118) cryopreserved homografts for right ventricular outflow reconstruction between January 1985 and October 1993. Patient survival, including operative mortality, 5 years after the operation was similar between the two groups (ulmonary homograft 86%, aortic homograft 80%; p = not significant by log-rank test). However, 5-year freedom from homograft failure 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 homografts became moderately or severely calcified compared with 4% of pulmonary homografts ( p < 0.001). Twenty-six percent of aortic homografts in children 4 years old or younger had moderate or severe obstruction associated with calcification, whereas only 11% of aortic homografts in patients 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 homograft related. Risk factors for patient mortality and homograft failure (defined as either need for homograft replacement because of homograft failure ( p < 0.0001), but type of homograft was not correlated with patient mortality. Age 4 years or younger was a significant risk factor for homograft failure ( p < 0.0001), but type of homograft was not correlated with patient mortality. Age 4 years or younger was a significant risk factor for both mortality ( p < 0.01) and homograft failure ( p = 0.03) in aortic homograft recipients but not in pulmonary homograft recipients. These results indicate that both aortic and pulmonary homografts provided excellent intermediate-term patient survival after right ventricular outflow tract reconstruction, but pulmonary homografts are more durable than aortic homografts with less calcification and obstruction, especially among children 4 years old or younger. (J T HORAC C ARDIOVASC SURG 1995; 109: 509-18).

Original languageEnglish (US)
Pages (from-to)509-518
Number of pages10
JournalThe Journal of thoracic and cardiovascular surgery
Volume109
Issue number3
DOIs
StatePublished - Mar 1995

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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