Long-term outcome of right ventricular outflow tract reconstruction with bicuspidalized homografts

Given the shortage of small-sized cryopreserved homografts for right ventricle (RV) to pulmonary artery (PA) reconstructions, more readily available larger-sized homografts can be used after size reduction by bicuspidalization. The aim of our study was to determine and compare function over time of standard and bicuspidalized homografts in infants younger than 12 months, including patients with a Ross or extended Ross procedure.

All consecutives infants under the age of 1 year, who underwent a surgical procedure in which a homograft was placed in the RV-PA position between January 1994 and April 2009, were included. Prospectively collected data from serial, standardized echocardiography from all patients were extracted from the database, and hospital records were retrospectively reviewed.

A total of 40 infants had a valved homograft conduit placed in the RV-PA position. In 20 of those patients, a bicuspidalized homograft was used. Twelve patients underwent a Ross procedure, of whom seven had an additional Konno-type aortic annulus enlargement. Median follow-up was 146 months (interquartile range (IQR), 117-170; total patient years: 178) in the group with standard use of the homograft and 95 months (IQR, 11-104; total patient years: 78) in the group with bicuspidalized conduits. Freedom from re-intervention (re-operation or percutaneous) was not different in the standard and bicuspidalized groups for all and Ross or Konno-Ross procedures (Tarone-Ware, p = 0.65 and p = 0.47, respectively). Consecutive echocardiographic maximum velocities in the right ventricular outflow tract were similar in the standard and bicuspidalized groups.

When proper sized cryopreserved homografts for placement in the RV-PA position in Ross, Konno-Ross, and other procedures in infants under the age of 1 year are not readily available, bicuspidalized homografts provide an acceptable alternative.