Factors influencing medium-term performance of right-sided cryopreserved homografts

Between February 1987 and December 1996, 187 children and young adults underwent right ventricular outflow tract (RVOT) reconstruction with aortic or pulmonary homografts.

Patients were allocated to four groups according to preoperative diagnosis: RVOT obstructions with ventriculo-arterial (VA) concordance (n = 90), RVOT obstructions with VA discordance (n = 26), truncus arteriosus (n = 19) and RVOT reconstruction after the Ross procedure (n = 52). RVOT reconstruction was a reoperation in 49.7% of cases. A pulmonary homograft was used in preference (87% in concordant, 90% in Ross, 79% in truncus, and 50% in discordant groups).

Five patients died after homograft repair (hospital mortality rate 2.7%). Mean follow up was 34 +/- 27 months. Four patients died during subsequent follow up; hence actuarial survival rate was 93 +/- 2% at 60 months. All other patients are currently in NYHA class I or II. Nine patients underwent reoperation because of homograft dysfunction. Overall survival was 90 +/- 3% at 60 months.

Uni- and multivariate analysis identified young age at correction, the use of aortic homografts, corrections in patients with VA discordance, and longer aortic cross-clamp time as independent predictors of homograft failure.