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 cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease.


RESULTS
Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9+/-7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88% at 10 years. Freedom from homograft failure was 74+/-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 previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients </=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 adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.
Tweddell
J S
JS
Department of Surgery (Cardiothoracic Surgery), Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA. jstwedde@mcw.edu
Pelech
A N
AN
Frommelt
P C
PC
Mussatto
K A
KA
Wyman
J D
JD
Fedderly
R T
RT
Berger
S
S
Frommelt
M A
MA
Lewis
D A
DA
Friedberg
D Z
DZ
Thomas
J P
JP
Sachdeva
R
R
Litwin
S B
SB
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001021:Aortic Valve / Q000637:transplantation*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011664:Pulmonary Valve / Q000637:transplantation*; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000601:surgery*