In recent years, the use of allograft conduits in repair of congenital cardiac disease is widely accepted. However, the supply of homograft is currently limiting their increased clinical application, especially small cryopreserved homografts for
use in
neonates and infants. We used a technique to surgically reduce the size of the more readily available large-diameter allografts, making them suitable for right ventricular outflow tract reconstruction in small infants and children. From December
1994 to
March 1996, a total of 11 patients ranging in age from 10 months to 6 years(mean age, 27.3 months) and ranging in weight from 5.6 to 18.5kg (mean 11.5kg) underwent reconstruction of the right ventricular outflow tract using this surgical
technique(pulmonary atresia with ventricular septal defect, 9 cases ; tetralogy of Fallot, 2 cases). The diameter after downsizing ranged from 14 to 19 mm with mean of 16.8 mm. There was one operative death due to rupture of the infected
homograft.
Evaluation of these patients between 2 and 15 months (mean 6.9 months) after homograft implantation reveals excellent clinical and echocardiographic results. There were no significant homograft insufficiency and RVOT obstructions. Although a
longer
follow-up is certainly required to evaluate the long term fate of the surgically modified bicuspid homografts, we believe that this technique may represent a valuable therapeutic alternative, at least in the short term, to the use of synthetic
grafts
wen an appropriately sized homograft is not available.
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