Long-term follow-up after primary complete repair of common arterial trunk with homograft: A 40-year experience

Background We sought to determine the long-term performance of homograft and truncal valve after complete repair of common arterial trunk. Methods From January 1964 to June 2008, 32 patients (median age, 14 days; range, 5 days to 2.5 years) underwent primary homograft repair of common arterial trunk. Twenty-four (75%) were neonates. The homograft used in the right ventricular outflow tract was aortic in 24 patients and pulmonary in 8 patients (mean diameter, 15.8 ± 3.5 mm; median diameter, 16 mm [range, 8–24 mm]). The median follow-up was 24.5 years (range, 5.6 months to 43.5 years). Results There were 3 hospital deaths and 1 late death. The actuarial survival at 30 years was 83.1% ± 6.6%. Of the 28 survivors, 25 reoperations were performed in 19 (76%) patients. The mean and median times to homograft reoperation were 11.5 ± 7.4 and 12.1 years (range, 1.0–26.1 years), respectively. Overall freedom from homograft reoperation after 10, 20, and 30 years was 68.4% ± 8.7%, 37.4% ± 9.5%, and 26.7% ± 9.3%, respectively. Twelve patients retained the original homografts at a median follow-up of 16.4 years (range, 0–30.2 years). Six underwent a truncal valve replacement with a mechanical prosthesis at a median of 10.5 years (range, 3.4–22 years) after truncus repair. Freedom from truncal valve replacement at 10 and 30 years was 93.1% ± 4.7% and 81.8% ± 8.9%, respectively. In the 22 surviving patients who did not undergo truncal valve replacement, the peak truncal valve gradient was 8.9 ± 8.3 mm Hg at a median follow-up of 24.5 years (range, 5.6 months to 32.9 years). At the last follow-up, 27 (96.4%) patients had good left ventricular function, and 24 patients (85.7%) were New York Heart Association class I. Conclusions Oversizing the homograft at the time of the initial repair can lead to a homograft lasting more than 12 years. During long-term follow-up, 20% of patients require truncal valve replacement.