title: Extending the usable size range of homografts in the pulmonary circulation: outcome of bicuspid homografts.
abstract: 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.
authors.affiliation: Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Bhagawan
authors.initials: B
authors.lastname: Koirala
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Merklinger
authors.forename: Glen S
authors.initials: GS
authors.lastname: Van Arsdell
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.forename: John G
authors.initials: JG
authors.lastname: Coles
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
mesh_terms: 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