Right ventricular outflow reconstruction with homografts

Ninety children and young adults underwent right ventricular outflow tract (RVOT) reconstruction with aortic or pulmonary homografts from May, 1989 to May, 1994. The patients were divided into three groups according to preoperative diagnosis: RVOT obstructions with ventriculo-arterial (VA) concordance (61), RVOT obstructions with VA discordance (18) and truncus arteriosus (11). Of the reconstructions, 52% were reoperations. A pulmonary homograft was used by preference (85% in the concordant group and 33% in the discordant group). One patient died after homograft correction (hospital mortality 1.1%). The mean follow-up was 32 +/- 22 months. One patient died after 10 months due to congestive heart failure and obstructive pulmonary hypertension. All other patients were in NYHA classes I-II. Three patients (two discordant and one truncus correction) underwent reoperation because of aortic homograft dysfunction and calcification. The incidence of significant (> or = 40 mmHg) gradient across the reconstruction found at the last echocardiographic control was 4% in the concordant, 28% in the discordant, and 18% in the truncus, group. Echocardiographic evidence of moderate (grade 2-3/4) pulmonary regurgitation (PR) was noticed in 24 and 13% of the concordant and discordant groups, respectively. From this medium-term experience it is concluded that (1) the medium-term performance of cryopreserved homografts is excellent, even in young patients, (2) corrections in patients with VA discordance need close follow-up, (3) the use of pulmonary homografts, especially in VA concordant lesions, should be encouraged, (4) longer-term follow-up is necessary to confirm the superiority of the cryopreserved homograft when compared to the porcine xenograft in the RVOT.