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Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease
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. Among 205 patients receiving cryopreserved homografts for reconstruction of the RVOT between November 1985 and A...
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| Published in: | Circulation (New York, N.Y.) N.Y.), 2000-11, Vol.102 (19 Suppl 3), p.III130-III-135 |
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| container_end_page | III-135 |
| container_issue | 19 Suppl 3 |
| container_start_page | III130 |
| container_title | Circulation (New York, N.Y.) |
| container_volume | 102 |
| creator | Tweddell, J S Pelech, A 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, Jr, J P Sachdeva, R Litwin, S B |
| description | 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.
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 |
| doi_str_mv | 10.1161/01.cir.102.suppl_3.iii-130 |
| format | article |
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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.
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.cir.102.suppl_3.iii-130</identifier><identifier>PMID: 11082375</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Age Distribution ; Aortic Valve - transplantation ; Cardiac Surgical Procedures - mortality ; Child ; Child, Preschool ; Cryopreservation ; Disease-Free Survival ; Follow-Up Studies ; Graft Survival ; Heart Defects, Congenital - complications ; Heart Defects, Congenital - surgery ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Pulmonary Valve - transplantation ; Risk Factors ; Survival Rate ; Transplantation, Homologous - statistics & numerical data ; Ventricular Outflow Obstruction - etiology ; Ventricular Outflow Obstruction - surgery</subject><ispartof>Circulation (New York, N.Y.), 2000-11, Vol.102 (19 Suppl 3), p.III130-III-135</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3365-a5ebdd3fd3c4df439c243da83c611da54ed238313057933046507760de1063b33</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11082375$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tweddell, J S</creatorcontrib><creatorcontrib>Pelech, A N</creatorcontrib><creatorcontrib>Frommelt, P C</creatorcontrib><creatorcontrib>Mussatto, K A</creatorcontrib><creatorcontrib>Wyman, J D</creatorcontrib><creatorcontrib>Fedderly, R T</creatorcontrib><creatorcontrib>Berger, S</creatorcontrib><creatorcontrib>Frommelt, M A</creatorcontrib><creatorcontrib>Lewis, D A</creatorcontrib><creatorcontrib>Friedberg, D Z</creatorcontrib><creatorcontrib>Thomas, Jr, J P</creatorcontrib><creatorcontrib>Sachdeva, R</creatorcontrib><creatorcontrib>Litwin, S B</creatorcontrib><title>Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.
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.
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Distribution</subject><subject>Aortic Valve - transplantation</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cryopreservation</subject><subject>Disease-Free Survival</subject><subject>Follow-Up Studies</subject><subject>Graft Survival</subject><subject>Heart Defects, Congenital - complications</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Proportional Hazards Models</subject><subject>Pulmonary Valve - transplantation</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><subject>Transplantation, Homologous - statistics & numerical data</subject><subject>Ventricular Outflow Obstruction - etiology</subject><subject>Ventricular Outflow Obstruction - surgery</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><recordid>eNpFUU1rGzEQFSWhcdL-hSJ6yG03kmY_7N6KyceCoRDas5Clka0ir7aS1sXn_PEoxJDTzBvmvce8IeQ7ZzXnHb9jvNYu1pyJOs3T5CXUzrmKA_tEFrwVTdW0sLogC8bYqupBiCtyndLfAjvo28_kinO2FKVdkJcHpXOIiSprUWc37qgP4w6PLp9osHQfDmEXlc30qPwRE50TGupGGt1uX4Y45uj07FWkYc7Wh_80xyJJI-owphznIhpGakOk-k14dFl5ukcVMzUuoUr4hVxa5RN-Pdcb8ufh_vf6qdr8ehzWPzeVBujaSrW4NQasAd0Y28BKiwaMWoLuODeqbdAIWEKJoe1XAKzpWtb3HTPIy91bgBty-647xfBvxpTlwSWN3qsRw5xkLxrBSsJl8cf7oo4hpYhWTtEdVDxJzuTbCyTjcj08Fyjk-QVyGAZZvAv529ll3h7QfFDPmcMrZreJRg</recordid><startdate>20001107</startdate><enddate>20001107</enddate><creator>Tweddell, J S</creator><creator>Pelech, A N</creator><creator>Frommelt, P C</creator><creator>Mussatto, K A</creator><creator>Wyman, J D</creator><creator>Fedderly, R T</creator><creator>Berger, S</creator><creator>Frommelt, M A</creator><creator>Lewis, D A</creator><creator>Friedberg, D Z</creator><creator>Thomas, Jr, J P</creator><creator>Sachdeva, R</creator><creator>Litwin, S B</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20001107</creationdate><title>Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease</title><author>Tweddell, J S ; Pelech, A 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, Jr, J P ; Sachdeva, R ; Litwin, S B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3365-a5ebdd3fd3c4df439c243da83c611da54ed238313057933046507760de1063b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Distribution</topic><topic>Aortic Valve - transplantation</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cryopreservation</topic><topic>Disease-Free Survival</topic><topic>Follow-Up Studies</topic><topic>Graft Survival</topic><topic>Heart Defects, Congenital - complications</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Proportional Hazards Models</topic><topic>Pulmonary Valve - transplantation</topic><topic>Risk Factors</topic><topic>Survival Rate</topic><topic>Transplantation, Homologous - statistics & numerical data</topic><topic>Ventricular Outflow Obstruction - etiology</topic><topic>Ventricular Outflow Obstruction - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tweddell, J S</creatorcontrib><creatorcontrib>Pelech, A N</creatorcontrib><creatorcontrib>Frommelt, P C</creatorcontrib><creatorcontrib>Mussatto, K A</creatorcontrib><creatorcontrib>Wyman, J D</creatorcontrib><creatorcontrib>Fedderly, R T</creatorcontrib><creatorcontrib>Berger, S</creatorcontrib><creatorcontrib>Frommelt, M A</creatorcontrib><creatorcontrib>Lewis, D A</creatorcontrib><creatorcontrib>Friedberg, D Z</creatorcontrib><creatorcontrib>Thomas, Jr, J P</creatorcontrib><creatorcontrib>Sachdeva, R</creatorcontrib><creatorcontrib>Litwin, S B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tweddell, J S</au><au>Pelech, A N</au><au>Frommelt, P C</au><au>Mussatto, K A</au><au>Wyman, J D</au><au>Fedderly, R T</au><au>Berger, S</au><au>Frommelt, M A</au><au>Lewis, D A</au><au>Friedberg, D Z</au><au>Thomas, Jr, J P</au><au>Sachdeva, R</au><au>Litwin, S B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2000-11-07</date><risdate>2000</risdate><volume>102</volume><issue>19 Suppl 3</issue><spage>III130</spage><epage>III-135</epage><pages>III130-III-135</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>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.
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.
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.</abstract><cop>United States</cop><pmid>11082375</pmid><doi>10.1161/01.cir.102.suppl_3.iii-130</doi></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2000-11, Vol.102 (19 Suppl 3), p.III130-III-135 |
| issn | 0009-7322 1524-4539 |
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| source | EZB Electronic Journals Library |
| subjects | Adolescent Adult Age Distribution Aortic Valve - transplantation Cardiac Surgical Procedures - mortality Child Child, Preschool Cryopreservation Disease-Free Survival Follow-Up Studies Graft Survival Heart Defects, Congenital - complications Heart Defects, Congenital - surgery Humans Infant Infant, Newborn Middle Aged Multivariate Analysis Proportional Hazards Models Pulmonary Valve - transplantation Risk Factors Survival Rate Transplantation, Homologous - statistics & numerical data Ventricular Outflow Obstruction - etiology Ventricular Outflow Obstruction - surgery |
| title | Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease |
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