Calcification of homograft valves in the pulmonary circulation -- is it device or donation related?
OBJECTIVE
Homograft valved conduits are used in the reconstruction of right ventricular outflow tract (RVOT), and calcification is a recognised phenomenon in these devices. The purpose of this study was to assess the effect of type (pulmonary and aortic) and mode of harvest of these cryopreserved homografts (cadaveric and beating heart) on the incidence of calcification of these conduits when used in the pulmonary circulation.


METHODS
A retrospective study was carried out on 60 patients with congenital heart defects who underwent reconstruction of RVOT using cryopreserved homograft valved conduits. The homografts were harvested from two different groups of donors; beating heart donors and cadaveric donors. The period of study was from 1st January 1990 to 31st December 2000. There were 34 males and 26 females, and the median age was 75 months. The 30-day mortality was 10 (16.7%). The 50 survivors were followed-up 3-108 months (median 36 months). Twenty-four had aortic homografts and 26 pulmonary homografts. Twenty-four devices were from cadaveric donors and 26 from beating heart donors.


RESULTS
There were 10 (20%) calcified devices, all aortic in origin. In a logistic regression analysis, aortic homografts were significant risk factor for calcification (P=0.0006). However, source of harvest was not significantly related to the incidence of calcification (P=0.6).


CONCLUSIONS
Cryopreserved pulmonary homografts placed in the right side of the heart are less likely to undergo calcification. Homografts harvested from beating heart donors do not appear to reduce the incidence of calcification.
Javadpour
H
H
Department of Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland. hossein@iol.ie
Veerasingam
D
D
Wood
A E
AE
D000328:Adult; D019917:Blood Vessel Prosthesis Implantation; D002102:Cadaver; D002114:Calcinosis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009926:Organ Preservation; D011183:Postoperative Complications; D011664:Pulmonary Valve / Q000637:transplantation*; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous