Cryopreserved valved femoral vein homografts for right ventricular outflow tract reconstruction in infants

Abstract

Background: We have previously reported use of cryopreserved valve femoral vein homograft (FVH) conduits for biventricular repairs in infants needing right ventricular outflow tract (RVOT) reconstruction. This study aims to compare FVH conduits with aortic (A) and pulmonary (P) homografts with regards to intermediate-and long-term outcomes.Methods: Retrospective review was conducted of all infants between 2004 and 2016 who underwent biventricular repair with RVOT reconstruction using homograft conduits. Patients were divided into A, P, and FVH groups based upon type of conduit received (N ¼ 57 [A ¼ 13; P ¼ 21, FVH ¼ 23]). Groups were compared using univariate and multivariable Cox regression analyses. The Nelson-Aalen estimator of cumulative hazard and Kaplan-Meier curves were used to identify differences in freedom from catheter reintervention and reoperation.Results: The 2 groups were comparable except for greater incidence of delayed sternal closure and longer hospital length of stay in the FVH group. The followup was longer for A and P groups compared with the FVH group (P<.001). Multivariable Cox regression, adjusting for difference in the length of follow-up, revealed comparable freedom from overall reintervention between the groups. Younger age at implantation was the only independent predictor of overall reintervention (hazard ratio per day younger age, 1.06; 95% confidence interval, 1.02-1.11; P ¼ .002). Nelson-Aalen cumulative hazard analysis revealed greater freedom from percutaneous reintervention with use of FVH. Kaplan-Meier analysis showed comparable freedom from reoperation for all three conduits.Conclusions: Valved femoral vein homograft conduits are comparable with aortic and pulmonary homografts for RVOT reconstruction in infants undergoing biventricular repairs.

Unidirectional reversed Potts shunt with reinforced valved femoral vein homograft

“…We have previously published our experience with this graft in the right ventricular outflow tract position, which has yielded comparable results with aortic or pulmonary homografts. 4 Therefore, we suggest the consideration of reinforced femoral vein grafts for the creation of rPS, although longer follow-up with a larger group of patients is warranted to determine the durability of this conduit and the prognosis of the patients.…”

Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves

“…5,112 The emergence of TPVR has clearly transformed PVR therapy, but outcomes should be evaluated compared to surgical PVR outcomes which are still considered to be the benchmark. 113 Current surgical options for PVR include stented bioprosthetic valves, [114][115][116] (porcine and pericardial), homografts 8,117,118 (pulmonary, aortic, and femoral vein valved conduits), xenografts 119,120 (bovine jugular venous valved conduits), heterografts 121 (Dacron graft stented porcine valved conduit), and surgeon-made conduits 122,123 (GoreTex valved conduit). [124][125][126][127] Pulmonary valve repair is appropriate for specific circumstances, such as isolated cusp injury resulting in significant pulmonary regurgitation but is otherwise rarely employed for pulmonary valve dysfunction.…”

Past, present, and future options for right ventricular outflow tract reconstruction

“…Another less frequently used option is the implantation of a femoral vein homograft in the right ventricular outflow tract position (32,33).…”