Complications Following Homograft Replacement of the Right Ventricular Outflow Tract

Twenty-two patients who had surgical reconstruction of the pulmonary artery and right ventricular outflow tract with a complete or partial valve-bearing aortic homograft have been followed for 1 to 5 years. The following complications were noted: (1) calcification of the homograft (10 patients; noted within the first postoperative year in 6 patients and 2 to 4 years after operation in the remaining 4); (2) pulmonary valve insufficiency (12 patients, including 8 with complete three-cusped aortic homografts); (3) residual obstruction (4 patients), primarily at the distal anastomosis; and (4) sudden, unexpected death (1 patient), which occurred 18 months after operation from rupture of the right ventricular outflow tract. Although the immediate postoperative results with aortic homografts are good, late complications are frequent. We have concluded that aortic homografts are not ideal for right ventricular outflow tract reconstruction. Further development and evaluation of a suitable valve-bearing prosthesis is necessary since the goals of reconstruction in this group of patients continue to be relief of obstruction and establishment of a functionally competent right ventricle-to-pulmonary artery conduit.