Mark R. Bielefeld, Deborah A. Bishop, Frederick L. Grover*, David R. Clarke

University of Colorado Health Sciences Center and The Children’s Hospital

Denver, Colorado, USA

Repair of the right ventricular outflow tract (RVOT) using an aortic or pulmonary valve homograft is often the procedure of choice in children with complex cardiac anomalies. Homografts are implanted with the knowledge that reoperation might be required whether due to outgrowth or structural degeneration. Fourteen years of homograft RVOT reconstruction in the pediatric population was reviewed to assess the feasibility of homograft replacement.

From February 1985 through March 1999, 223 children underwent first time reconstruction of the RVOT with an aortic or pulmonary homograft. There were 31 (14%) early deaths and one patient was lost to follow-up. Of the 223 children, 191 children have been followed up for 1 month to 14 years. Thirty seven patients (19%) have undergone explantation of their original RVOT homograft. Thirty-five explants were done at the implanting hospital with insertion of a second homograft valve conduit 2 months to 13.3 years after the first implantation.

The 35 patients who underwent homograft explant were 6 days to 6.1 years of age at initial operation and were 2.5 months to 19.5 years old at reoperation. There were three hospital deaths (9%) and one child with dilated cardiomyopathy underwent early cardiac transplant. Thirty-one reoperative survivors have been followed up for 3 months to 12.4 years. There have been two late deaths unrelated to the homograft and one rereplacement.

Homograft replacement can be accomplished with reasonably low morbidity and mortality.