Durability of RV-PA Homograft at Pulmonic Position in Congenital Heart Procedures at Rajavithi Hospital

Chanokporn Daowan, Kampoo Foofuengmonkolkit, Pirapat Mokarapong

Cardiovascular Thoracic Surgery Unit, Rajavithi hospital, Bangkok, Thailand

Date, time and location: 2018.05.25 15:30, Press Hall, 2F

Abstract

Objectives.

A homograft considered as a standard conduit in right ventricular outflow tract reconstruction. We sought to determine the patients in long-term outcome, conduit longevity and durability after right ventricular outflow tract reconstruction using homograft in pulmonic position.

Methods.

We retrospectively review patients underwent right ventricular outflow tract reconstruction using homograft in pulmonic position between 1st January 1998 and 31st December 2016 in Rajavithi Hospital. There are four major operations including Rastelli’s operation, Ross procedure, Trancal repair and RV-PA reconstruction. Two methods of homograft preservation used in our study, one from Rajavithi-preserved homograft and one from Thai national bank preparation.

Results.

A total of 138 patients with right ventricular outflow tract reconstruction using homograft in pulmonic position in this study. 58.7% were male with mean age of 8.90 ± 5.72 years. The major diagnosis of pulmonary atresia with a ventricular septal defect was 39.86%, congenital aortic valve disease 23.91%, complex transposition 15.22%, double outlet right ventricle 10.87% , tetralogy of Fallot 6.52% and truncus arteriosus 3.62%. Rastelli’s operation performed in 71.7%, Ross procedure 23.0%, truncal repair 3.6% and RV-PA reconstruction 0.7%. Homograft using in our study was harvest from aortic origin 73.91% and pulmonic origin 26.09%. Among this homograft, Rajavithi-preserved homograft was 49.3% and from Thai national bank preparation 50.7%. The overall 5-year survival was 93.48%, and 10-year survival was 91.30%. Homograft harvested from pulmonic origin was the only predictor for homograft degeneration in multivariate analysis (p=0.003). Freedom from explantation was 97.22%, 88.89% and 75.0% at 5, 10 and 15 years. There are no patients explanted or died with complication of homograft endocarditis.

Conclusions.

RV-PA homograft implantation in the pulmonic position can perform with good long-term freedom from explantation and provide excellently outcome. Factors affect homograft durability include a patient with truncus arteriosus, homograft from the pulmonic origin and Rajavithi-preserved homograft.