title: Long term results of right ventricular outflow tract reconstruction with homografts.
abstract: BACKGROUND
  Homograft cardiac valves and valved-conduits have been available in our institute since 1992. We sought to determine the long-term outcome after right ventricular outflow tract (RVOT) reconstruction using homografts, and risk factors for reoperation were analyzed.
  
  
  METHODS
  We retrospectively reviewed 112 patients who had undergone repair using 116 homografts between 1992 and 2008. Median age and body weight at operation were 31.2 months and 12.2 kg, respectively. The diagnoses were pulmonary atresia or stenosis with ventricular septal defect (n=93), congenital aortic valve diseases (n=15), and truncus arteriosus (N=8). Mean follow-up duration was 79.2±14.8 months.
  
  
  RESULTS
  There were 10 early and 4 late deaths. Overall survival rate was 89.6%, 88.7%, 86.1% at postoperative 1 year, 5 years and 10 years, respectively. Body weight at operation, cardiopulmonary bypass (CPB) time and aortic cross-clamping (ACC) time were identified as risk factors for death. Forty-three reoperations were performed in thirty-nine patients. Freedom from reoperation was 97.0%, 77.8%, 35.0% at postoperative 1 year, 5 years and 10 years respectively. Small-sized graft was identified as a risk factor for reoperation.
  
  
  CONCLUSIONS
  Although long-term survival after RVOT reconstruction with homografts was excellent, freedom from reoperation was unsatisfactory, especially in patients who had small grafts upon initial repair. Thus, alternative surgical strategies not using small grafts may need to be considered in this subset.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
authors.forename: Hye-Won
authors.initials: HW
authors.lastname: Kim
authors.forename: Dong-Man
authors.initials: DM
authors.lastname: Seo
authors.forename: Hong Ju
authors.initials: HJ
authors.lastname: Shin
authors.forename: Jeong-Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Yoon