Results of large pulmonary homograft implantation for right ventricular
outflow tract reconstruction
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.