Long-term follow-up after primary complete repair of common arterial trunk with homograft: a 40-year experience.
BACKGROUND
We sought to determine the long-term performance of homograft and truncal valve after complete repair of common arterial trunk.


METHODS
From January 1964 to June 2008, 32 patients (median age, 14 days; range, 5 days to 2.5 years) underwent primary homograft repair of common arterial trunk. Twenty-four (75%) were neonates. The homograft used in the right ventricular outflow tract was aortic in 24 patients and pulmonary in 8 patients (mean diameter, 15.8 +/- 3.5 mm; median diameter, 16 mm [range, 8-24 mm]). The median follow-up was 24.5 years (range, 5.6 months to 43.5 years).


RESULTS
There were 3 hospital deaths and 1 late death. The actuarial survival at 30 years was 83.1% +/- 6.6%. Of the 28 survivors, 25 reoperations were performed in 19 (76%) patients. The mean and median times to homograft reoperation were 11.5 +/- 7.4 and 12.1 years (range, 1.0-26.1 years), respectively. Overall freedom from homograft reoperation after 10, 20, and 30 years was 68.4% +/- 8.7%, 37.4% +/- 9.5%, and 26.7% +/- 9.3%, respectively. Twelve patients retained the original homografts at a median follow-up of 16.4 years (range, 0-30.2 years). Six underwent a truncal valve replacement with a mechanical prosthesis at a median of 10.5 years (range, 3.4-22 years) after truncus repair. Freedom from truncal valve replacement at 10 and 30 years was 93.1% +/- 4.7% and 81.8% +/- 8.9%, respectively. In the 22 surviving patients who did not undergo truncal valve replacement, the peak truncal valve gradient was 8.9 +/- 8.3 mm Hg at a median follow-up of 24.5 years (range, 5.6 months to 32.9 years). At the last follow-up, 27 (96.4%) patients had good left ventricular function, and 24 patients (85.7%) were New York Heart Association class I.


CONCLUSIONS
Oversizing the homograft at the time of the initial repair can lead to a homograft lasting more than 12 years. During long-term follow-up, 20% of patients require truncal valve replacement.
Vohra
Hunaid A
HA
Department of Cardiothoracic Surgery, Wessex Cardiac Unit, Southampton University Hospital Trust, Southampton, United Kingdom.
Whistance
Robert N
RN
Chia
Alicia X
AX
Janusauskas
Vilius
V
Nikolaidis
Nicholas
N
Roubelakis
Apostolos
A
Veldtman
Gruschen
G
Roman
Kevin
K
Vettukattil
Joseph J
JJ
Gnanapragasam
James
J
Salmon
Anthony P
AP
Monro
James L
JL
Haw
Marcus P
MP
D001011:Aorta / Q000637:transplantation*; D001807:Blood Vessel Prosthesis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002675:Child, Preschool; D015925:Cryopreservation; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D011651:Pulmonary Artery / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D017741:Survivors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left