Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation 2000 Nov 07;102(19 Suppl 3):III130-5
Date
11/18/2000Pubmed ID
11082375DOI
10.1161/01.cir.102.suppl_3.iii-130Scopus ID
2-s2.0-0034619332 (requires institutional sign-in at Scopus site) 242 CitationsAbstract
BACKGROUND: Few studies have explored the long-term function of cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease.
METHODS AND RESULTS: Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9+/-7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88% at 10 years. Freedom from homograft failure was 74+/-4% at 5 years and 54+/-7% at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z: value <2, and previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients </=1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z: value <2 and aortic valve type predicted homograft valve failure.
CONCLUSIONS: Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.
Author List
Tweddell JS, Pelech AN, Frommelt PC, Mussatto KA, Wyman JD, Fedderly RT, Berger S, Frommelt MA, Lewis DA, Friedberg DZ, Thomas JP Jr, Sachdeva R, Litwin SBAuthors
Raymond T. Fedderly MD Associate Professor in the Pediatrics department at Medical College of WisconsinPeter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Age Distribution
Aortic Valve
Cardiac Surgical Procedures
Child
Child, Preschool
Cryopreservation
Disease-Free Survival
Follow-Up Studies
Graft Survival
Heart Defects, Congenital
Humans
Infant
Infant, Newborn
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Pulmonary Valve
Risk Factors
Survival Rate
Transplantation, Homologous
Ventricular Outflow Obstruction