Long-term follow-up after primary complete repair of common arterial trunk with homograft: a 40-year experience

Vohra, Hunaid A., Whistance, Robert N., Chia, Alicia X., Janusauskas, Vilias, Nikolaidis, Nicholas, Roubelakis, Apostolos, Veldtman, Gruschen R., Roman, Kevin, Vettukattil, Joseph J., Gnanapragasam, James, Salmon, Anthony P., Monro, James L. and Haw, Marcus P. (2010) Long-term follow-up after primary complete repair of common arterial trunk with homograft: a 40-year experience. Journal of Thoracic Cardiovascular Surgery. (doi:10.1016/j.jtcvs.2009.12.052).

Abstract

Background

We sought to determine the long-term performance of homograft and truncal valve after complete repair of common arterial trunk.

Methods

From January 1964 to June 2008, 32 patients (median age, 14 days; range, 5 days to 2.5 years) underwent primary homograft repair of common arterial trunk. Twenty-four (75%) were neonates. The homograft used in the right ventricular outflow tract was aortic in 24 patients and pulmonary in 8 patients (mean diameter, 15.8 ± 3.5 mm; median diameter, 16 mm [range, 8–24 mm]). The median follow-up was 24.5 years (range, 5.6 months to 43.5 years).

Results

There were 3 hospital deaths and 1 late death. The actuarial survival at 30 years was 83.1% ± 6.6%. Of the 28 survivors, 25 reoperations were performed in 19 (76%) patients. The mean and median times to homograft reoperation were 11.5 ± 7.4 and 12.1 years (range, 1.0–26.1 years), respectively. Overall freedom from homograft reoperation after 10, 20, and 30 years was 68.4% ± 8.7%, 37.4% ± 9.5%, and 26.7% ± 9.3%, respectively. Twelve patients retained the original homografts at a median follow-up of 16.4 years (range, 0–30.2 years). Six underwent a truncal valve replacement with a mechanical prosthesis at a median of 10.5 years (range, 3.4–22 years) after truncus repair. Freedom from truncal valve replacement at 10 and 30 years was 93.1% ± 4.7% and 81.8% ± 8.9%, respectively. In the 22 surviving patients who did not undergo truncal valve replacement, the peak truncal valve gradient was 8.9 ± 8.3 mm Hg at a median follow-up of 24.5 years (range, 5.6 months to 32.9 years). At the last follow-up, 27 (96.4%) patients had good left ventricular function, and 24 patients (85.7%) were New York Heart Association class I.

Conclusions

Oversizing the homograft at the time of the initial repair can lead to a homograft lasting more than 12 years. During long-term follow-up, 20% of patients require truncal valve replacement.

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