Extending the usable size range of homografts in the pulmonary circulation: outcome of bicuspid homografts

Background. Small-sized homografts are often not available, making the use of surgically reduced cryopreserved homograft conduits appealing. Methods. From January 1993 to January 2000, 21 large homografts were size-reduced by excising one leaflet and were implanted in the pulmonary circulation. Valve function was compared with 21 children—matched for weight, homograft size, and year of operation—who received a standard homograft. Results. Implanted homograft size and patient weight were equivalent in both the bicuspid and standard groups. Median (range) in-hospital peak instantaneous echocardiographic gradient across the valve was 0 mm Hg (0 to 19) in the bicuspid group versus 0 mm Hg (0 to 17) in the standard group (p = 0.65). Median (range) in-hospital pulmonary insufficiency (scale of 0 to 4) was 2 (0 to 3) in the bicuspid group versus 1.5 (0 to 3) in the standard group (n = 10, p = 0.34). At a follow-up of 54 ± 29 months there was no significant difference in conduit reinterventions between the groups. Conclusions. Surgical creation of a bicuspid valve in the pulmonary circulation results in a functionally equivalent conduit compared with standard homograft as measured by early and midterm valve function.