Excellent durability of homografts in pulmonary position analysed in a predefined adult group with tetralogy of Fallot

OBJECTIVES In repaired tetralogy of Fallot, surgical pulmonary valve replacement (PVR) is in certain cases required. Our institution reported earlier about 26 patients who received a pulmonary homograft via PVR. To date, we have data from more than 17years of follow-up. The aim of this retrospective study was to evaluate the late haemodynamic and clinical outcomes in this predefined patient group. METHODS Between 1993 and 2001, 26 patients underwent PVR for pulmonary regurgitation (58% men; 30.48.9years). The rates of mortality and of complications (re-PVR, ablation and cardioverter defibrillator implants) were analysed. Other main study outcomes were haemodynamic parameters determined from cardiovascular magnetic resonance imaging: pulmonary regurgitation; right ventricular (RV) end-diastolic volume; RV ejection fraction; left ventricular (LV) end-diastolic volume; LV ejection fraction; New York Heart Association functional class at the latest follow-up visit; and echocardiographic parameters of the right ventricle. RESULTS The median follow-up time was 17 +/- 1.1years. Overall freedom from complications was 61.5% (95% confidence interval 47.5-78.6%). One patient died 18months after surgery of unknown causes. Two patients needed replacement of the homograft at 24 and 39months after PVR. The indication in both patients was recurrence of severe homograft regurgitation with important RV dilatation. Six patients received an implantable cardioverter defibrillator at a median age of 41years (interquartile range 36-47); 12 patients experienced supra- and/or ventricular arrhythmias and 6 of these needed ablation. There was no significant deterioration of haemodynamic function or functional class. CONCLUSIONS The patients who underwent PVR exhibited long-term follow-up stabilization of RV function and impressive functional durability of the graft. After a follow-up of 17years, 23 out of 26 patients (89%) were alive without redo PVR. Event-free survival was good (61.5%).