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Results of large pulmonary homograft implantation for right ventricular outflow tract reconstruction
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  • Simon DANG VAN,
  • Carine Pavy,
  • Guillaume Guimbretière,
  • Julie Boulanger,
  • Pierre Maminirina,
  • Patrice Guerin,
  • Olivier Baron
Simon DANG VAN
University Hospital Centre Angers
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Carine Pavy
University Hospital Centre Nantes
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Guillaume Guimbretière
University Hospital Centre Nantes
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Julie Boulanger
University Hospital Centre Nantes
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Pierre Maminirina
University Hospital Centre Nantes
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Patrice Guerin
University Hospital Centre Nantes
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Olivier Baron
University Hospital Centre Nantes
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Abstract

Background : To evaluate the long-term results of implantation of homogeneous large size of pulmonary homograft (PH) for reconstruction of the right ventricular outflow tract (RVOT). Methods : Between January 2000 and December 2017, 107 patients were implanted with PH for reconstruction of the RVOT. Data were collected retrospectively in this single-center study. PH failure was defined as a peak of gradient > 40 mmHg and/or as a pulmonary regurgitation > grade 2. Primary endpoint was the re-operation of the RVOT during follow-up. Secondary endpoints were overall survival, occurrence of PH failure and the rate of re-operation for all cause. Results : Mean age of the recipients was 26.13  13.59 years. Mean size of PH was 23.02  6.87 mm. Re-operation of the RVOT occurred in 8 patients (7.8%). Time before re-operation was 2.74 years (Interquartile Range: 6.41). Freedom from re-operation for RVOT at 5 and 10 years was respectively 95.7% and 90.0%. Overall survival at 10 years was 95.2%. PH failure occurred in 13 patients (12.0%). Mean time before PH failure was 5.00  4.35 years. Freedom from PH failure at 10 years was 81.6%. Re-operation for PH failure occurred in 4 patients (3.9%). Concomitant tricuspid valve surgery (p=0.037), initial pulmonary stenosis (p=0.04), recipient of PH < 16 years old (p=0.043) were risk factors of late reoperation in univariate analysis. Multivariate analysis showed no independent risk factor of late reoperation. Conclusions : Implantation of large PH for RVOT reconstruction provides excellent mid-term results in terms of re-operation.

Peer review status:UNDER REVIEW

16 Jun 2020Submitted to Journal of Cardiac Surgery
17 Jun 2020Submission Checks Completed
17 Jun 2020Assigned to Editor
18 Jun 2020Reviewer(s) Assigned
02 Jul 2020Review(s) Completed, Editorial Evaluation Pending
08 Jul 2020Editorial Decision: Revise Major
21 Sep 20201st Revision Received
23 Sep 2020Submission Checks Completed
23 Sep 2020Assigned to Editor
23 Sep 2020Reviewer(s) Assigned