Evaluation of downsized homograft conduits for right ventricle-to-pulmonary artery reconstruction

Objective: Although homograft conduits are frequently used to establish right ventricle-to-pulmonary artery continuity, the limited availability of small-size homografts is a significant constraint in pediatric cardiac surgery. We compared the performance of standard homograft conduits with that of surgically reduced bicuspid homograft conduits in patients undergoing repair of truncus arteriosus. Methods: Forty infants undergoing complete repair of truncus arteriosus with either standard homografts ( n = 26) or reduced-size bicuspid homografts ( n = 14) were evaluated. Results: The median downsized conduit diameter ( 13 mm) was similar to the standard homograft diameter ( 12 mm, P = .52). There were 6 early deaths and 5 late deaths, representing an overall 30-day mortality of 15% and a 5-year mortality of 25%. No deaths were directly related to homograft dysfunction. Four ( 29%) downsized conduits and 8 ( 31%) standard conduits required replacement at a median interval of 18.5 months and 42.4 months, respectively. Catheter-based interventions were required in 5 ( 36%) patients in the downsized group and in 3 ( 12%) patients in the standard group. There was no difference in freedom from surgical or catheter-based reintervention between the 2 groups ( P = .42). Freedom from conduit failure ( severe conduit stenosis, moderate or greater regurgitation) was 55.9% and 17.2% at 3 years in the downsized and standard groups, respectively. Conclusion: The surgically downsized homograft is an excellent option when an appropriate-sized homograft is not available and might prevent morbidity associated with the use of an oversized conduit.