Orthotopic pulmonic valve replacement with a pulmonary homograft as an interposition graft

Pulmonary regurgitation (PR) following nonvalved reconstruction of the right ventricular outflow tract is usually well tolerated. However, a small percentage of patients develop progressive right ventricular dilatation and failure due to long-standing PR. When this group of patients becomes refractory to medical management, pulmonic valve replacement (PVR) may offer symptomatic relief and hemodynamic improvement. From a cumulative experience, the pulmonary homograft may be the optimal choice for PVR due to its very low transvalvular gradient assuring optimal hemodynamics, the absence of anticoagulation-related and thromboembolic complications, and the excellent mid-term results when compared to other valved conduit, including the aortic homograft. We report our experience in two patients who have been operated upon at the BWH between March and August 1995 for severe pulmonary valve insufficiency and right heart failure, who received cryopreserved pulmonary homografts. We also describe our technique of PVR using a pulmonary homograft as an orthotopic root replacement.