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Long-term results of homograft valves in extracardiac conduits
R S Almeida1, R K Wyse, M R de Leval
1Cardiothoracic Unit, Hospital for Sick Children, London, UK.
Insights
Aortic homograft conduits used within 3 weeks of harvesting offer good durability for up to 12 years. Avoid longer storage and Dacron extensions to prevent obstruction in extracardiac valved conduits.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Pediatric Cardiology
Background:
- Extracardiac valved conduits are used in complex heart surgeries.
- Aortic homografts are a type of biological conduit.
- Understanding factors affecting homograft durability is crucial for patient outcomes.
Purpose of the Study:
- To identify risk factors for obstruction in aortic homograft conduits.
- To evaluate the long-term performance of aortic homografts.
- To provide recommendations for optimal use of aortic homografts.
Main Methods:
- Retrospective analysis of 335 patients receiving extracardiac valved conduits.
- Detailed analysis of patients who received aortic homograft conduits.
- Multivariate analysis to identify significant risk factors for obstruction.
Main Results:
- Time interval between harvesting and use (P < 0.02) and earlier operation date (P < 0.05) were major risk factors for obstruction.
- Homografts used within 3 weeks had 79% freedom from obstruction at 8 years, versus 55% for those used between 3-6 weeks.
- Homografts used alone showed significantly better freedom from obstruction (93% at 10 years) compared to those extended with Dacron tubes (52% at 10 years).
Conclusions:
- Aortic homografts are reasonably durable conduits for up to 12 years when used within 3 weeks of harvesting.
- Longer storage times and extension with woven Dacron tubes are associated with increased obstruction risk.
- Optimal use involves timely implantation and avoiding Dacron extensions for better long-term outcomes.
Abstract:
Between 1971 and 1986, 335 patients received various extracardiac valved conduits between one of the heart chambers and the pulmonary arteries. The group of patients who received aortic homograft conduits and survived the operation were analysed in detail. The age varied between 9 days and 18 years (mean 7.1 +/- 0.7 years), weight 2.4 kg-63.5 kg (mean 17.8 +/- 10.8 kg). The diameter of the conduit used was 10-30 mm (mean 20.8 mm). Multivariate analysis revealed a highly significant model (P less than 0.005) which showed that the time interval between harvesting and use of the homograft (P less than 0.02) and the earlier date of operation (P less than 0.05) were the major risk factors for obstruction. Homografts used within 3 weeks of harvesting had freedom from obstruction of 79% at 8 years; homografts used between 3-6 weeks had freedom from obstruction of only 55% at 8 years. Homografts used alone performed significantly better than those extended with woven Dacron tubes. At 10 years, 93% of homografts used alone were free of obstruction compared to 52% of homografts extended with a Dacron tube. We conclude that aortic homografts used within 3 weeks of harvesting provide a reasonably durable conduit for a period of 12 years. Longer storage, and extension of the homograft with a woven Dacron tube should be avoided.