Korean J Thorac Cardiovasc Surg.  2011 Apr;44(2):108-114. 10.5090/kjtcs.2011.44.2.108.

Long Term Results of Right Ventricular Outflow Tract Reconstruction with Homografts

• Kim HW
• Seo DM
• Shin HJ
• Park JJ
• Yoon TJ

• KMID: 1448568
• DOI: http://doi.org/10.5090/kjtcs.2011.44.2.108

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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Ventricular outflow tract obstruction, right; Homograft; Conduit

MeSH Terms

Aortic Valve
Body Weight
Cardiopulmonary Bypass
Constriction, Pathologic
Follow-Up Studies
Freedom
Heart Septal Defects, Ventricular
Heart Valves
Humans
Pulmonary Atresia
Reoperation
Retrospective Studies
Risk Factors
Survival Rate
Transplantation, Homologous
Transplants
Truncus Arteriosus