Application status of right ventricular outflow tract reconstruction with valved homograft conduits: 13 years’ clinical analysis of a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DUN Yaojun , ZHAO Dong , HUA Zhongdong , YAN Jun , LI Shoujun ,  YANG Keming

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;

Corresponding author：

YANG Keming, Email: 13801217526@163.com

Keywords：

Valved homograft conduit; right ventricular outflow tract; long-term durability; risk factor

DOI：

10.7507/1007-4848.202105087

Video：

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Objective To evaluate the clinical outcome of valved homograft conduits (VHC) used for right ventricular outflow tract (RVOT) reconstruction in Fuwai Hospital in recent 13 years, and explore the factors influencing the long-term durability of VHC. Methods Clinical data of patients using VHC for RVOT reconstruction in Fuwai Hospital from November 2007 to October 2020 were retrospectively analyzed. The Kaplan-Meier survival curve was used to evaluate survival, VHC reintervention and VHC dysfunction. Cox proportional risk regression model was used to analyze the risk factors for VHC dysfunction. Results Finally 251 patients were enrolled, including 145 males and 106 females. The median age at surgery was 6.0 (0.3-67.0) years. Early death occurred in 5 (2.0%) patients. The follow-up was available for 239 (95.2%) patients, with the follow-up time of 0.3-160.0 (61.3±45.4) months. Five patients died during the follow-up, and the 1-year, 6-year, and 13-year survival rates were 96.6%, 95.5% and 95.5%, respectively. Eight patients received VHC reintervention during the follow-up, and freedom rates from VHC reintervention were 100.0%, 97.1% and 82.4% at 1 year, 6 years and 13 years, respectively. A total of 226 patients were followed up by echocardiography after discharge, with the follow-up time of 0.2-138.0 (48.5±40.5) months. During the follow-up, 46 (20.4%) patients developed VHC dysfunction, and freedom rates from VHC dysfunction at 1 year, 5 years, and 10 years were 92.6%, 79.6% and 59.3%, respectively. Univariate Cox regression analysis showed that age<6 years and VHC diameter<19 mm were risk factors for VHC dysfunction (P=0.029, 0.026), but multivariate regression analysis only indicated that age<6 years was an independent risk factor for VHC dysfunction (P=0.034). Conclusion The early and late outcomes of VHC used for RVOT reconstruction are satisfactory, and the long-term durability of VHC is also optimal. In addition, age<6 years is an independent risk factor for VHC dysfunction.

Citation： DUN Yaojun, ZHAO Dong, HUA Zhongdong, YAN Jun, LI Shoujun, YANG Keming. Application status of right ventricular outflow tract reconstruction with valved homograft conduits: 13 years’ clinical analysis of a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 1019-1024. doi: 10.7507/1007-4848.202105087 Copy

1.	Ross DN, Somerville J. Correction of pulmonary atresia with a homograft aortic valve. Lancet, 1966, 2(7479): 1446-1447.
2.	Tweddell JS, Pelech AN, Frommelt PC, et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation, 2000, 102(19Suppl3): Ⅲ130-Ⅲ135.
3.	张晶, 刘迎龙, 谢宁, 等. 同种带瓣管道应用的远期效果. 中华胸心血管外科杂志, 2001, 17(2): 68-70.
4.	Niwaya K, Knott-Craig CJ, Lane MM, et al. Cryopreserved homograft valves in the pulmonary position: Risk analysis for intermediate-term failure. J Thorac Cardiovasc Surg, 1999, 117(1): 141-146.
5.	Sharifulin R, Bogachev-Prokophiev A, Demin I, et al. Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg, 2021, 59(1): 162-169.
6.	Stark J. The use of valved conduits in pediatric cardiac surgery. Pediatr Cardiol, 1998, 19(4): 282-288.
7.	O'Brien MF, Stafford G, Gardner M, et al. The viable cryopreserved allograft aortic valve. J Card Surg, 1987, 2(1Suppl): 153-167.
8.	Herrmann JL, Brown JW. Seven decades of valved right ventricular outflow tract reconstruction: The most common heart procedure in children. J Thorac Cardiovasc Surg, 2020, 160(5): 1284-1288.
9.	Forbess JM, Shah AS, St Louis JD, et al. Cryopreserved homografts in the pulmonary position: Determinants of durability. Ann Thorac Surg, 2001, 71(1): 54-59.
10.	Kalfa D, Macé L, Metras D, et al. How to choose the best available homograft to reconstruct the right ventricular outflow tract. J Thorac Cardiovasc Surg, 2011, 142(4): 950-953.
11.	Bando K, Danielson GK, Schaff HV, et al. Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg, 1995, 109(3): 509-517.
12.	Kalfa DM, Loundou A, Nouaille de Gorce Y, et al. Pulmonary position cryopreserved homograft in non-Ross patients: How to improve the results? Eur J Cardiothorac Surg, 2012, 42(6): 981-987.
13.	Selamet Tierney ES, Gersony WM, Altmann K, et al. Pulmonary position cryopreserved homografts: Durability in pediatric Ross and non-Ross patients. J Thorac Cardiovasc Surg, 2005, 130(2): 282-286.
14.	Boethig D, Goerler H, Westhoff-Bleck M, et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg, 2007, 32(1): 133-142.
15.	胡小松, 杨克明, 李守军, 等. 同种带瓣管道用于右心室流出道重建的中期效果. 中国循环杂志, 2016, 31(4): 385-388.
16.	Livi U, Abdulla AK, Parker R, et al. Viability and morphology of aortic and pulmonary homografts. A comparative study. J Thorac Cardiovasc Surg, 1987, 93(5): 755-760.

1. Ross DN, Somerville J. Correction of pulmonary atresia with a homograft aortic valve. Lancet, 1966, 2(7479): 1446-1447.
2. Tweddell JS, Pelech AN, Frommelt PC, et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation, 2000, 102(19Suppl3): Ⅲ130-Ⅲ135.
3. 张晶, 刘迎龙, 谢宁, 等. 同种带瓣管道应用的远期效果. 中华胸心血管外科杂志, 2001, 17(2): 68-70.
4. Niwaya K, Knott-Craig CJ, Lane MM, et al. Cryopreserved homograft valves in the pulmonary position: Risk analysis for intermediate-term failure. J Thorac Cardiovasc Surg, 1999, 117(1): 141-146.
5. Sharifulin R, Bogachev-Prokophiev A, Demin I, et al. Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg, 2021, 59(1): 162-169.
6. Stark J. The use of valved conduits in pediatric cardiac surgery. Pediatr Cardiol, 1998, 19(4): 282-288.
7. O'Brien MF, Stafford G, Gardner M, et al. The viable cryopreserved allograft aortic valve. J Card Surg, 1987, 2(1Suppl): 153-167.
8. Herrmann JL, Brown JW. Seven decades of valved right ventricular outflow tract reconstruction: The most common heart procedure in children. J Thorac Cardiovasc Surg, 2020, 160(5): 1284-1288.
9. Forbess JM, Shah AS, St Louis JD, et al. Cryopreserved homografts in the pulmonary position: Determinants of durability. Ann Thorac Surg, 2001, 71(1): 54-59.
10. Kalfa D, Macé L, Metras D, et al. How to choose the best available homograft to reconstruct the right ventricular outflow tract. J Thorac Cardiovasc Surg, 2011, 142(4): 950-953.
11. Bando K, Danielson GK, Schaff HV, et al. Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg, 1995, 109(3): 509-517.
12. Kalfa DM, Loundou A, Nouaille de Gorce Y, et al. Pulmonary position cryopreserved homograft in non-Ross patients: How to improve the results? Eur J Cardiothorac Surg, 2012, 42(6): 981-987.
13. Selamet Tierney ES, Gersony WM, Altmann K, et al. Pulmonary position cryopreserved homografts: Durability in pediatric Ross and non-Ross patients. J Thorac Cardiovasc Surg, 2005, 130(2): 282-286.
14. Boethig D, Goerler H, Westhoff-Bleck M, et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg, 2007, 32(1): 133-142.
15. 胡小松, 杨克明, 李守军, 等. 同种带瓣管道用于右心室流出道重建的中期效果. 中国循环杂志, 2016, 31(4): 385-388.
16. Livi U, Abdulla AK, Parker R, et al. Viability and morphology of aortic and pulmonary homografts. A comparative study. J Thorac Cardiovasc Surg, 1987, 93(5): 755-760.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application status of right ventricular outflow tract reconstruction with valved homograft conduits: 13 years’ clinical analysis of a single center

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