Fifteen years' experience with the aortic homograft: the conduit of choice for right ventricular outflow tract reconstruction.

Ninety-seven patients with pulmonary atresia underwent right ventricular outflow tract reconstruction using a homograft conduit. There were 46 hospital deaths (47%). Hospital mortality was significantly related to irreversible pulmonary hypertension (p less than 0.001) and thoracotomy for ligation of bronchial collaterals (p less than 0.01). The actuarial survival was 37 +/- 7% at 10 years. Sixteen patients undergoing recatheterization at a mean of 6 years had a mean transconduit gradient of 24 +/- 15 mm Hg. Obstructed conduits (i.e., with a gradient of greater than 50 mm Hg) were replaced in 3 patients, corresponding to 13 +/- 8% at 10 years. In each instance, the obstruction was due to neointimal hyperplasia in the Dacron tube rather than calcification of the homograft valve. The fresh, antibiotic-sterilized aortic homograft is the conduit of choice for right ventricular outflow tract reconstruction. The valve itself appears more resistant to calcification than its xenograft counterpart, and the absence of Dacron removes the problem of fibrinous peel obstructing the conduit. We now construct a tube of autologous pericardium to increase the length of the conduit and avoid complementary thoracotomy for ligation of bronchial collaterals.