Intermediate-term results of repair of congenital heart diseases using pulmonary homografts

Abstract

Objective: We evaluate our intermediate-term results of our patients who had insertion of homografts for repair of their congenital heart diseases since the first application in April 1999. Background: Use of homograft valve in the repair of complex congenital heart lesions has been a standard for over two decades. However, homograft is not available locally because of lack of donor. Since 1999, we were able to obtain limited supply of homograft from England. Methods: Between 26 April 1999 and 28 February 2005, 45 patients had insertion of homografts for repair of congenital heart disease. The mean age of operation was 7.2±6.2 years (33 days-28 years). The mean follow-up duration was 32.5±20.6 months (0.03-71 months). The follow-up clinical status was reviewed. Overall survival and freedom from reoperation due to conduit failure were estimated by Kaplan-Meier method. Homograft valve stenosis or regurgitation was assessed by serial echocardiography and cardiac catheterisation. Results: There were one early death (2.2%) and two late deaths (4.4%). One of the late deaths died from non-cardiac cause due to severe bronchial stenosis. The actuarial survival was 93% at 71 months. Of the 42 survivors, majority had improved functional status significantly. There were 40 patients (95%) in NYHA class I or II. Three patients (6.7%) required reoperation for conduit failure. The freedom from reoperation was 85% at 71 months. One patient is awaiting reoperation for severe pulmonary homograft and aortic (truncal) regurgitation. Homograft conduit function of the remaining patients was satisfactory on follow-up. Conclusion: This study showed satisfactory intermediate-term outcome in patients after cardiac operations using homograft.