Factors affecting longer of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease

J. S. Tweddell, Andrew N Pelech, P. C. Frommelt, K. A. Mussatto, J. D. Wyman, R. T. Fedderly, S. Berger, M. A. Frommelt, D. A. Lewis, D. Z. Friedberg, Jr Thomas J.P., R. Sachdeva, S. B. Litwin

Research output: Contribution to journalArticle

187 Citations (Scopus)

Abstract

Background - Few studies have explored the long-term function of cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease. Methods and Results - Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9±7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88% at 10 years. Freedom from homograft failure was 74±4% at 5 years and 54±7% at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z value <2, and previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients ≤1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z value <2 and aortic valve type predicted homograft valve failure. Conclusions - Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.

Original languageEnglish (US)
JournalCirculation
Volume102
Issue number19
StatePublished - Nov 7 2000
Externally publishedYes

Fingerprint

Allografts
Heart Diseases
Warm Ischemia
Tissue Donors
Survival
Aortic Valve
Survivors
Pathologic Constriction

Keywords

  • Congenital
  • Heart defect
  • Surgery
  • Valves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Tweddell, J. S., Pelech, A. N., Frommelt, P. C., Mussatto, K. A., Wyman, J. D., Fedderly, R. T., ... Litwin, S. B. (2000). Factors affecting longer of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation, 102(19).

Factors affecting longer of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. / Tweddell, J. S.; Pelech, Andrew N; Frommelt, P. C.; Mussatto, K. A.; Wyman, J. D.; Fedderly, R. T.; Berger, S.; Frommelt, M. A.; Lewis, D. A.; Friedberg, D. Z.; Thomas J.P., Jr; Sachdeva, R.; Litwin, S. B.

In: Circulation, Vol. 102, No. 19, 07.11.2000.

Research output: Contribution to journalArticle

Tweddell, JS, Pelech, AN, Frommelt, PC, Mussatto, KA, Wyman, JD, Fedderly, RT, Berger, S, Frommelt, MA, Lewis, DA, Friedberg, DZ, Thomas J.P., J, Sachdeva, R & Litwin, SB 2000, 'Factors affecting longer of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease', Circulation, vol. 102, no. 19.
Tweddell, J. S. ; Pelech, Andrew N ; Frommelt, P. C. ; Mussatto, K. A. ; Wyman, J. D. ; Fedderly, R. T. ; Berger, S. ; Frommelt, M. A. ; Lewis, D. A. ; Friedberg, D. Z. ; Thomas J.P., Jr ; Sachdeva, R. ; Litwin, S. B. / Factors affecting longer of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. In: Circulation. 2000 ; Vol. 102, No. 19.
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abstract = "Background - Few studies have explored the long-term function of cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease. Methods and Results - Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9±7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88{\%} at 10 years. Freedom from homograft failure was 74±4{\%} at 5 years and 54±7{\%} at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z value <2, and previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients ≤1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z value <2 and aortic valve type predicted homograft valve failure. Conclusions - Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.",
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AU - Tweddell, J. S.

AU - Pelech, Andrew N

AU - Frommelt, P. C.

AU - Mussatto, K. A.

AU - Wyman, J. D.

AU - Fedderly, R. T.

AU - Berger, S.

AU - Frommelt, M. A.

AU - Lewis, D. A.

AU - Friedberg, D. Z.

AU - Thomas J.P., Jr

AU - Sachdeva, R.

AU - Litwin, S. B.

PY - 2000/11/7

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N2 - Background - Few studies have explored the long-term function of cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease. Methods and Results - Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9±7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88% at 10 years. Freedom from homograft failure was 74±4% at 5 years and 54±7% at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z value <2, and previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients ≤1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z value <2 and aortic valve type predicted homograft valve failure. Conclusions - Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.

AB - Background - Few studies have explored the long-term function of cryopreserved homograft valves used for reconstruction of the right ventricular tract (RVOT) in patients with congenital heart disease. Methods and Results - Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and April 1999, the outcome of 220 homografts in 183 operative survivors was analyzed. There were 150 pulmonary and 70 aortic homografts used. Median age at implantation was 4.4 years (mean 6.9±7.6 years, range 3 days to 48 years). End points included (1) patient survival, (2) homograft failure (valve explant or late death), and (3) homograft dysfunction (homograft insufficiency or homograft stenosis). Survival was 88% at 10 years. Freedom from homograft failure was 74±4% at 5 years and 54±7% at 10 years. Univariable analysis identified younger age, longer donor warm ischemic time, valve Z value <2, and previous procedure as risk factors for homograft failure and dysfunction. Aortic homograft type and extracardiac operative technique predicted homograft failure but not dysfunction. For patients ≤1 year of age, valve type did not predict failure or dysfunction. Multivariable analysis identified younger age and longer donor warm ischemic time as risk factors for homograft failure and dysfunction, whereas, Z value <2 and aortic valve type predicted homograft valve failure. Conclusions - Homograft valves used for RVOT reconstruction provide effective intermediate palliation with excellent late survival. Factors that adversely affect graft longevity include younger age, longer donor warm ischemic time, smaller homograft size, use of aortic homograft in the older patient, and extracardiac operative technique.

KW - Congenital

KW - Heart defect

KW - Surgery

KW - Valves

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