Right ventricle to pulmonary artery reconstruction using a valved homograft

Although the valved homograft is widely used to establish a connection between the right ventricle (RV) and the pulmonary artery (PA), its durability remains controversial. In the present study, the data on 141 valved homograft implantations in 107 consecutive patients performed from January 1990 to June 2000 were analyzed. The mean follow-up period was 4.6 years (range, 0.2-9.4 years). The clinical data, including clinic records, operative notes, follow-up visits, and letters from referring physicians, were analyzed with particular reference to variables associated with early and late mortality, deterioration of the homograft, and risk factors for patient survival and homograft failure. Early death occurred in 7.5% (n=8) of the cases, and each of these patients died without leaving the hospital. Late death occurred in 2 patients, for whom the cause of death was suggested to be related to arrhythmia. Thirteen patients underwent catheter intervention (ie, balloon dilatation and/or stenting) and 8 of these did not require homograft replacement following catheterization. The overall survival rate at both 3 years and 5 years was 88.9+/-3.4%. Cumulative freedom from total homograft failure was 82.5+/-3.6% at 1 year; 61.6+/-5.0% at 3 years; and 42.4+/-6.2% at 5 years. In comparison with 2 criteria of homograft failure (ie, total homograft failure and homograft failure including catheter intervention), the incidence of freedom from homograft failure including catheter intervention was lower than that of total homograft failure, although the difference was not statistically significant. In the multivariate analysis, significant risk factors with respect to patient survival were homograft replacement and the use of expanded polytetrafluoroethylene (ePTFE); those judged to be significant with respect to homograft failure were total repair with first homograft implantation and diagnosis of truncus arteriosus. The valved homograft was thus considered an appropriate choice of conduit between the RV and the PA, and it provided excellent patient survival. However, this type of homograft did not provide a completely permanent solution for the repair of complex cardiac anomalies. Therefore, the use of ePTFE for homograft extensions should be avoided. Finally, the results suggest that catheter intervention plays an important role in the longevity of the implanted homograft.