Late results of homograft function used for right ventricular outflow obstruction

Abstract

The concept of using a homograft aortic valve and length of aorta as a conduit to reconstruct the right ventricular outflow tract (RVOTR) was introduced in 1966 by Ross (1) in the National Heart Hospital, London. The patient, a 9-year-old with complex pulmonary atresia now, 21 years later, works as a garage mechanic and is the father of three healthy children. The original valve was replaced after 9 years. The technique has been modified successfully to repair other congenital cyanotic anomalies. It was quickly tried by several centres in the U.S.A. but condemned because of rapid degeneration of the valve due to destructive sterilisation methods. We have continued the use of the aortic homograft for RVOTR since 1966, only using something else when there was none available. As there is now a renaissance in use of the commercially prepared homografts in America, it would seem appropriate to examine the longterm results, paying attention to the fate of the homograft rather than the patient. In order to reduce the influence of natural history of the basic lesion, only patients with Fallot, pulmonary atresia and ventricular septal defect, and absent pulmonary valve are included.