Factors related to the durability of a homograft monocusp valve inserted during repair of tetralogy of Fallot as based on the mid- to long-term outcomes.
OBJECTIVE
To maintain pulmonary valvar function subsequent to repair of tetralogy of Fallot, we have inserted a homograft monocusp when a transjunctional patch was required. In this study, we have evaluated the mid- to long-term outcomes, aiming to determine the durability of the homograft.


METHODS
Among 218 repairs performed for tetralogy of Fallot between July, 1996, and June, 2005, we inserted homograft monocusps in 54 patients, 4 of whom had associated absent pulmonary valve syndrome, 3 had pulmonary valvar atresia, and 1 had an atrioventricular septal defect with common atrioventricular junction. The median body weight at surgery was 7.8 kilograms, with a range from 3.9 to 42 kilograms. The function of the monocusp valve was assessed by regular echocardiography, using the Kaplan-Meier method and the Cox regression model for statistical analyses.


RESULTS
There were 2 early deaths (3.7%), associated with respiratory infection. No late deaths were observed during the follow-up, which ranged from 0.3 to 120 months, with a median of 64.3 months. Freedom from valvar dysfunction was 67.2 +/- 6.7% at 1 year, 37.1 +/- 7.3% at 3 years, 23.8 +/- 6.7% at 5 years, and 21.2 +/- 6.4% at 7 years. We needed to replace the valve in 1 patient during follow-up. We found that ABO blood group incompatibility, stenosis of the pulmonary arteries, and associated absent pulmonary valve syndrome all adversely affected the function of the monocusp.


CONCLUSIONS
Our experiences show that insertion of a homograft monocusp can prevent pulmonary regurgitation in the early period after repair of tetralogy of Fallot, but the effects are limited in duration as degeneration progressed. We still need to determine whether this finding can improve the longer-term function of the right ventricle.
Yang
Ji-Hyuk
JH
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jun
Tae-Gook
TG
Park
Pyo W
PW
Sung
Kiick
K
Kim
Wook S
WS
Lee
Young T
YT
Huh
June
J
Kang
I-Seok
IS
Lee
Heung J
HJ
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D018633:Pulmonary Atresia / Q000601:surgery; D011664:Pulmonary Valve / Q000002:abnormalities*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D013771:Tetralogy of Fallot / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome