Long-term follow-up of valved homografts in right ventricle-to-pulmonary artery reconstruction: A comprehensive case series.

Abstract

Background: This study aims to evaluate the long-term outcomes of patients undergoing right ventricle-to-pulmonary artery reconstruction with valved homografts.

Methods: A total of 106 patients (49 males, 57 females; median age: 5 years; range, 2 to 49 years) who underwent right ventricle-to-pulmonary artery reconstruction between January 2002 and January 2024 were retrospectively analyzed. The study utilized cryopreserved homografts and surgical procedures were conducted under moderate hypothermic conditions using cardiopulmonary bypass. Homograft failure was defined as the need for reintervention or replacement. The primary outcome measures were overall survival, freedom from conduit replacement rate, and freedom from any required reinterventions rate.

Results: The median follow-up was 7 years. The overall survival rate was 92.5%, with early mortality primarily due to low cardiac output. Freedom from reintervention rates were 90.8%, 84.8%, and 76.3% at three, five, and 10 years, respectively. Thirteen patients required conduit replacement, with pulmonary homografts showing improved durability. Risk factors for homograft failure included pulmonary valve regurgitation treatment, lower patient weight, younger age, and female sex.

Conclusion: This study highlights the excellent survival and durability of valved homografts in cardiac reconstruction, with implications for patient management and surgical decision-making in complex congenital heart disease procedures.