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J Thorac Cardiovasc Surg 2006;132:66-71
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Evaluation of downsized homograft conduits for right ventricle–to–pulmonary artery reconstruction

^a Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
^b Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia.

Received for publication June 2, 2005; revisions received January 3, 2006; accepted for publication February 17, 2006.

^_* Address for reprints: Christian Pierre Robert Brizard, MD, Cardiac Surgery Unit, The Royal Children's Hospital, Flemington Rd, Parkville, Victoria, 3052, Australia. (Email: christian.brizard{at}rch.org.au).

OBJECTIVE: Although homograft conduits are frequently used to establish right ventricle–to–pulmonary artery continuity, the limited availability of small-size homografts is a significant constraint in pediatric cardiac surgery. We compared the performance of standard homograft conduits with that of surgically reduced bicuspid homograft conduits in patients undergoing repair of truncus arteriosus.

METHODS: Forty infants undergoing complete repair of truncus arteriosus with either standard homografts (n = 26) or reduced-size bicuspid homografts (n = 14) were evaluated.

RESULTS: The median downsized conduit diameter (13 mm) was similar to the standard homograft diameter (12 mm, P = .52). There were 6 early deaths and 5 late deaths, representing an overall 30-day mortality of 15% and a 5-year mortality of 25%. No deaths were directly related to homograft dysfunction. Four (29%) downsized conduits and 8 (31%) standard conduits required replacement at a median interval of 18.5 months and 42.4 months, respectively. Catheter-based interventions were required in 5 (36%) patients in the downsized group and in 3 (12%) patients in the standard group. There was no difference in freedom from surgical or catheter-based reintervention between the 2 groups (P = .42). Freedom from conduit failure (severe conduit stenosis, moderate or greater regurgitation) was 55.9% and 17.2% at 3 years in the downsized and standard groups, respectively.

CONCLUSION: The surgically downsized homograft is an excellent option when an appropriate-sized homograft is not available and might prevent morbidity associated with the use of an oversized conduit.

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