Evaluation of downsized homograft conduits for right ventricle-to-pulmonary artery reconstruction.
OBJECTIVE
Although homograft conduits are frequently used to establish right ventricle-to-pulmonary artery continuity, the limited availability of small-size homografts is a significant constraint in pediatric cardiac surgery. We compared the performance of standard homograft conduits with that of surgically reduced bicuspid homograft conduits in patients undergoing repair of truncus arteriosus.


METHODS
Forty infants undergoing complete repair of truncus arteriosus with either standard homografts (n = 26) or reduced-size bicuspid homografts (n = 14) were evaluated.


RESULTS
The median downsized conduit diameter (13 mm) was similar to the standard homograft diameter (12 mm, P = .52). There were 6 early deaths and 5 late deaths, representing an overall 30-day mortality of 15% and a 5-year mortality of 25%. No deaths were directly related to homograft dysfunction. Four (29%) downsized conduits and 8 (31%) standard conduits required replacement at a median interval of 18.5 months and 42.4 months, respectively. Catheter-based interventions were required in 5 (36%) patients in the downsized group and in 3 (12%) patients in the standard group. There was no difference in freedom from surgical or catheter-based reintervention between the 2 groups (P = .42). Freedom from conduit failure (severe conduit stenosis, moderate or greater regurgitation) was 55.9% and 17.2% at 3 years in the downsized and standard groups, respectively.


CONCLUSIONS
The surgically downsized homograft is an excellent option when an appropriate-sized homograft is not available and might prevent morbidity associated with the use of an oversized conduit.
McMullan
David Michael
DM
Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Oppido
Guido
G
Alphonso
Nelson
N
Cochrane
Andrew Donald
AD
d'Acoz
Yves d'Udekem
Yd
Brizard
Christian P
CP
D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D002404:Catheterization; D006324:Heart Arrest, Induced; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014339:Truncus Arteriosus, Persistent / Q000601:surgery*