Homografts in Pulmonar Position: Complications a Year After Surgery

pp. 457-462

Abstract

The purpose of this report was to evaluate the results of homografts between the right ventricle and the pulmonary artery, during the first year after operation. Seventy-nine consecutive patients aged 22 days to 292 months with homografts inserted in a subpulmonary position between 1991 and 2001, followed up for at least 12 months were included in the study. The median length of the follow-up was 40 months(14-124 months). The operated congenital heart lesions were: Fallot' stetralogy, 29%; pulmonar atresia and VSD, 25%; truncus arteriosus, 22%; transposition of the great arteries with VSD and pulmonary stenosis, 9%; L-TGA with VSD and PS, 9%; double outlet right ventricle, 5%. The median weight at operation was 15 kg (1,5-56 kg). The size of the homograft ranged between 9 and 26mm, mean = 19 mm. A pulmonary homograft was placed in 51% (n = 40) of the patients andan aortic homograft in the remaining 49% (n =39). In 11% (n=9), a change of homograft was needed between 15 and 122 months, mean = 61months after insertion, without operative mortality. It became obstructed in 8 patients who had a right ventricular systolic pressure over 75% of systemic level and an aneurysmal dilation was documented in one. An interventional procedure was performed in14 patients to reduce a systolic gradient. An episode of infective endocarditis was success-fully treated in 1 patient.

Conclusions:

1) The mid-term results of homografts between right ventricle and pulmonary artery were very good; 2) 11% needed a homograft replacement five years after; 3) the change of homograft was a very low risk procedure and4)failure of the homograft was dueto obstruction at the proximal right ventricular insertion or at the distal anastomoses to the pulmonary artery.