Pulmonary position cryopreserved homografts: durability in pediatric Ross and non-Ross patients.
OBJECTIVE
The purpose of this study was to evaluate the outcome and risk factors for implant failure in pediatric patients who underwent pulmonary position homograft placement for right ventricular outflow tract obstruction compared with conduit placement as a component of the Ross operation. Actuarial 5-year survivals for cryopreserved right ventricle-to-pulmonary artery homografts range from 55% to 94% at all ages. It is not known whether there is a difference in homograft durability when utilized for right ventricular outflow tract obstruction or as part of the Ross operation.


METHODS
The records of all pediatric patients receiving a right ventricle-to-pulmonary artery homograft from July 1989 through October 2003 were reviewed. Ninety-eight consecutive patients were studied (26 Ross, 72 non-Ross). In addition to Ross versus non-Ross comparisons, other potential risk factors for homograft failure analyzed included age at operation, follow-up time, type of surgery, and homograft type and size.


RESULTS
Ross and non-Ross patients were comparable in age at the time of the operation and follow-up time. Homograft failure rates were 12% and 51% for Ross and non-Ross patients, respectively. Freedom from reintervention was 93% in the Ross and 66% in the non-Ross group at 5 years (P = .019). On multivariate analysis, non-Ross operation and age less than 2 years were significant predictors of homograft failure.


CONCLUSIONS
1. Pediatric patients undergoing the Ross operation have longer homograft survival than pediatric patients treated for right ventricular outflow tract obstruction, independent of age. 2. Homografts placed in patients less than 2 years of age have shorter homograft survival.
Selamet Tierney
Elif Seda
ES
Division of Pediatric Cardiology, Children's Hospital of New York, Columbia University, New York, NY, USA. Seda.Tierney@cardio.chboston.org
Gersony
Welton M
WM
Altmann
Karen
K
Solowiejczyk
David E
DE
Bevilacqua
Laura M
LM
Khan
Chava
C
Krongrad
Ehud
E
Mosca
Ralph S
RS
Quaegebeur
Jan M
JM
Apfel
Howard D
HD
D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011475:Prosthesis Failure; D012307:Risk Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000601:surgery*