Factors influencing the survival of cryopreserved homografts. The second homograft performs as well as the first.
OBJECTIVE
To determine the life span of cryopreserved homografts implanted in the right ventricular outflow tract and the factors influencing it.


METHODS
From 1989 through 2003, we reconstructed the pulmonary valve with 301 homografts in 272 patients (median age 13 years; range 4 days-69 years). Indications were tetralogy of Fallot (136), truncus (23), Rastelli repair (11), double outlet ventricle (13), endocarditis (5), and the Ross operation (84). Median follow-up was 5.7 years (range 0-14). We analyzed possible predictors of graft replacement by simple and multiple Cox regression.


RESULTS
Actuarial survival was 96+/-1.2% at 1, 95+/-1.4% at 5, and 94+/-1.5% at 10 years follow-up. Three homografts were explanted because of endocarditis (excluded from the analysis). Freedom from explantation was 99.6+/-0.4% at 1, 94.5+/-1.7% at 5, and 81.8+/-4.1% at 10 years. Variables, significantly related to explantation in the univariate analysis, were younger age, small graft size, implantation in a non-anatomical position, the aortic donor homograft, a shorter aortic cross-clamp time and the implantation of a second homograft. In the multiple model, non-anatomical position (P=0.001), smaller graft size (P<0.0001) or younger age (on square root scale, P<0.0001) and clamp time (P=0.01) remain as independent risk factors. Immunological variables, like blood group incompatibility, implantation of a second homograft and short warm ischemic time were not significant.


CONCLUSIONS
The life span of a cryopreserved homograft is determined by graft size (correlates with age) and the non-anatomic position (correlates with indication). In a specific patient, the second homograft performs as well as the first.
Meyns
Bart
B
Department of Cardiac Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. bart.meyns@uz.kuleuven.ac.be
Jashari
Ramadan
R
Gewillig
Marc
M
Mertens
Luc
L
Komárek
Arnost
A
Lesaffre
Emmanuel
E
Budts
Werner
W
Daenen
Willem
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation / Q000379:methods*; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000276:immunology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011664:Pulmonary Valve / Q000276:immunology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors