title: Homograft reconstruction of the right ventricular outflow tract in adults with congenital heart disease: a systematic review.
abstract: Reconstruction of the right ventricular outflow tract with a homograft is an established surgical method in congenital heart disease. Studies from children and adolescents suggest that homograft durability is shorter than the life expectancy of the patient; therefore, durability in adults is addressed in this systematic review. The PubMed database was searched in May 2012 and repeated in May 2015 with the terms 'homograft AND pulmonary valve', generating 665 hits. We included only studies involving more than 50 patients with a mean or median age >18 years. Six studies with a cumulative total of 560 patients were included. The long-term mortality rate was 2-8.8% at 8.1-10 years. Reintervention was common during patients' life spans, with a 10-year event-free survival rate of 78-80%. Early postoperative echocardiographic or magnetic resonance imaging defects appear to predict rapid homograft degeneration. Further studies on various malformations and risk markers for degeneration are needed to make qualified and accurate decisions regarding lifetime management.
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden kristofer.skoglund@gu.se.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Skoglund
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Eriksson
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Svensson
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Dellborg
mesh_terms: D064591:Allografts; D001021:Aortic Valve / Q000637:transplantation*; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*
keywords: Allograft; Congenital heart disease; Homograft; Pulmonary valve; Right ventricular outflow tract surgery; Systematic review