Longevity of homograft conduits for infant right ventricular outflow tract reconstruction in the modern era

Homograft conduits are widely used for right ventricular outflow tract (RVOT) reconstruction. The literature reports a 50% 2-year freedom from reoperation for infants age <1 year. Recently, decellularized homografts and transcatheter interventions have been purported to prolong conduit longevity. This study evaluated homograft longevity in the modern era.

All infants (age <1 year) receiving a homograft RVOT conduit at a single institution between 2006 and 2024 were reviewed. The cumulative incidence function was used to estimate the cumulative probability of reoperation within 2 years, accounting for the competing risk of death. A Fine-Gray regression model with subdistribution hazard ratios (sHRs) identified predictors for reoperation within 2 years. Data on transcatheter interventions also were collected to aid the analysis.

A total of 74 patients met the inclusion criteria, who had a median age of 1.8 months (interquartile range [IQR], 0.3-5.5 months) and median weight of 4.2 kg (IQR, 3.2-5.8 kg) at homograft implantation. The cumulative incidence was 44.1% for surgical reintervention within 2 years and 12.3% for death before reoperation. Younger age, lower weight, smaller homograft size, and lower homograft z-score were associated with increased early reoperation. Nineteen patients (25.7%) had a transcatheter intervention, including 6 (31.6%) before a surgical reoperation, 6 (31.6%) after a surgical reoperation, and 7 (36.8%) without a surgical reintervention.

Compared with the literature, time to operative reintervention after homograft RVOT reconstruction in infants age <1 year has not changed significantly in the modern era, despite the expanded use of decellularized homografts and catheter-based interventions.