Performance of aortic and pulmonary homografts in the right ventricular outflow tract in children.

Cryopreserved homografts have been used at the German Heart Institute Berlin since October 1986. Until 31st May 1994, cryopreserved aortic (AA) or pulmonary (PA) homografts were implanted in the pulmonary position and followed up in 104 patients. The mean age at operation was 5.5 years. The patients were treated with 3-5 mg/kg aspirin daily after the operation for three months. They all had routine echocardiographic evaluation of their homografts, 47 patients were studied by heart catheterization. Excellent functional results of the homograft valves were found in 92 patients (88.5%). Early degeneration of the homograft conduit leading to reoperation was observed in 12 patients. Freedom from wall calcification was 18% in aortic and 78% in pulmonary homografts while freedom from valve dysfunction in aortic and pulmonary homografts at 60 months was 60% and 67%, respectively. Freedom from reoperation was 81% overall, 78% and 84% in patients with aortic and pulmonary homografts respectively (p < 0.05). In conclusion, pulmonary homograft has proved to be more durable than the aortic homograft in the pulmonary position, hence it is the preferential valve for RVOT reconstruction in children.