Document Detail


Cryopreserved homograft valves in the pulmonary position: risk analysis for intermediate-term failure.
MedLine Citation:
PMID:  9869768     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to examine the durability of cryopreserved homografts used to replace the "pulmonary" valve and to identify factors associated with their late deterioration. METHODS: We reviewed our entire experience (1985-1997) with 331 survivors in whom cryopreserved homograft valves (pulmonary, n = 304; aortic, n = 27) were used to reconstruct the pulmonary outflow tract. Median age was 14 years (range, 2 days-62 years). Operations included Ross operation (n = 259), tetralogy of Fallot (n = 41), truncus arteriosus (n = 14), Rastelli operation (n = 11), and others (n = 6). Median follow-up was 3.8 years (range, 0.2-11.2 years); late echographic follow-up was complete for 97% of patients. Homograft failure was defined as the need for explantation and valve-related death; homograft dysfunction was defined as a pulmonary insufficiency grade 3/4 or greater and a transvalvular gradient of 40 mm Hg or greater. RESULTS: Homograft failure occurred in 9% (30 of 331 patients; Kaplan-Meier); freedom from failure was 82% +/- 4% at 8 years. Homograft dysfunction occurred in 12% (39 of 331 patients), although freedom from dysfunction was 76% +/- 4% at 8 years. For aortic homografts, this was 56% +/- 11%, compared to 80% +/- 4% for pulmonary homografts (P =.003). For patients aged less than 3 years (n = 38), this was 51% +/- 12%, compared with 87% +/- 4% for older patients (P =.0001). By multivariable analysis, younger age of homograft donors, non-Ross operation, and later year of operation were associated with homograft failure; younger age of homograft donors, later year of operation, and use of an aortic homograft were associated with homograft dysfunction. CONCLUSIONS: Homograft valves function satisfactorily in the pulmonary position at mid-term follow-up. The pulmonary homograft valve appears to be more durable than the aortic homograft valve in the pulmonary position.
Authors:
K Niwaya; C J Knott-Craig; M M Lane; K Chandrasekaren; E D Overholt; R C Elkins
Related Documents :
22008898 - De-novo headache with transient vertebro-basilar symptoms: role of embryonic hypoglossa...
8899918 - Clinical aspects of the ross procedure: indications and contraindications.
17365408 - Orthotopic total aortic root replacement model in adult sheep.
16480018 - Repeat right ventricular outflow tract reconstruction using the medtronic freestyle por...
8000268 - The "fully no-touch" technique for the internal thoracic-coronary artery anastomosis.
10834728 - Clinical assessment and management of massive hemoptysis.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  117     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-01-28     Completed Date:  1999-01-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  141-6; discussion 46-7     Citation Subset:  AIM; IM    
Affiliation:
Section of Thoracic and Cardiovascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aortic Valve / transplantation*
Child
Child, Preschool
Cryopreservation
Female
Heart Defects, Congenital / surgery*
Humans
Infant
Infant, Newborn
Male
Middle Aged
Multivariate Analysis
Prosthesis Failure
Pulmonary Valve / surgery,  transplantation*
Reoperation
Risk Assessment
Transplantation, Homologous

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Multiple ventricular septal defects: how and when should they be repaired?
Next Document:  Morphologic spectrum of Ebstein's malformation: revisitation relative to surgical repair.