We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Long-term clinical outcome and echocardiographic function of homografts in the right ventricular outflow tract †.
- Authors
Romeo, Jamie L R; Mokhles, M Mostafa; van de Woestijne, Pieter; Jong, Peter de; van den Bosch, Annemien; Beynum, Ingrid M van; Takkenberg, Johanna J M; Bogers, Ad J J C
- Abstract
View large Download slide View large Download slide OBJECTIVES Although homografts are often the preferred valve conduits for right ventricular outflow tract (RVOT) reconstruction, data on long-term homograft-related outcomes, durability and impact on quality of life (QoL) are scarce. The aim of this study was therefore to describe the long-term homograft function, clinical outcomes and QoL after RVOT reconstruction. METHODS We performed a single-centre retrospective analysis of all consecutive patients who underwent RVOT reconstruction with a homograft. Multiple subsequent allografts in the same patients were regarded as separate subjects. Valve-related events were analysed by Kaplan–Meier and Life Table methods. Serial echocardiographic measurements were analysed with mixed effects models. In addition, QoL was repeatedly assessed and compared with a matched general population. RESULTS In total, 701 consecutive homografts were implanted in 604 patients [59.6% males, mean age at operation 19.5 ± 15.2 (standard deviation)]. Hospital mortality was 3.3%. After 25 years follow-up, survival and freedom from valve replacement were 84 ± 4% and 56 ± 6%, respectively. Freedom from valve replacement after 15 years for patients under 1 year of age was 28 ± 14% years, for those between 1 and 18 years, 59 ± 8%, and for those older than 18 years, 82 ± 5%. The peak gradient increased predominantly in the first postoperative decade in infants and paediatric patients from 19 to 54 mmHg. In adults, the average gradient increased from 9 to 31 mmHg after 14 years. Compared to a gender- and age-matched Dutch population, patients reported lower vitality and general health but less bodily pain. Patients, in whom QoL was repeatedly assessed, reported lower scores on physical functioning and vitality after a 5-year follow-up period. However, we found no differences in any of the subscales in patients who underwent valve replacement during the 5-year interval. CONCLUSIONS Homografts are a durable valve alternative for RVOT reconstruction; in particular, adults show extensive freedom from valve replacement and report QoL comparable with healthy subjects. An online interactive application form created by our institution can be used to assess patient outcome after RVOT reconstruction with a homograft for different patient profiles.
- Subjects
RIGHT hemicolectomy; QUALITY of life; STANDARD deviations; HOSPITAL mortality
- Publication
European Journal of Cardio-Thoracic Surgery, 2019, Vol 55, Issue 3, p518
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezy265