Extending the usable size range of homografts in the pulmonary circulation: outcome of bicuspid homografts.
BACKGROUND
Small-sized homografts are often not available, making the use of surgically reduced cryopreserved homograft conduits appealing.


METHODS
From January 1993 to January 2000, 21 large homografts were size-reduced by excising one leaflet and were implanted in the pulmonary circulation. Valve function was compared with 21 children-matched for weight, homograft size, and year of operation-who received a standard homograft.


RESULTS
Implanted homograft size and patient weight were equivalent in both the bicuspid and standard groups. Median (range) in-hospital peak instantaneous echocardiographic gradient across the valve was 0 mm Hg (0 to 19) in the bicuspid group versus 0 mm Hg (0 to 17) in the standard group (p = 0.65). Median (range) in-hospital pulmonary insufficiency (scale of 0 to 4) was 2 (0 to 3) in the bicuspid group versus 1.5 (0 to 3) in the standard group (n = 10, p = 0.34). At a follow-up of 54+/-29 months there was no significant difference in conduit reinterventions between the groups.


CONCLUSIONS
Surgical creation of a bicuspid valve in the pulmonary circulation results in a functionally equivalent conduit compared with standard homograft as measured by early and midterm valve function.
Koirala
Bhagawan
B
Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Merklinger
Sandra L
SL
Van Arsdell
Glen S
GS
McCrindle
Brian W
BW
Borger
Michael A
MA
Caldarone
Christopher A
CA
Coles
John G
JG
Williams
William G
WG
D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008943:Mitral Valve / Q000637:transplantation*; D014184:Transplantation, Homologous