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Mariassunta Telesca
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Alessandro Mazzucco
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LETTER TO THE EDITOR

Bicuspidized Pulmonary Homograft: an Old Technique but Still a Valuable Option

Francesco Santini, MD, Mariassunta Telesca, MD, Giuseppe Faggian, MD, Alessandro Mazzucco, MD

Division of Cardiac Surgery, University of Verona, Piazzale Stefani 1, 37126 Verona, Italy

To the Editor:

We read with interest the paper by Benjacholamas et al. relative to the use of bicuspidized pulmonary homograft for right ventriculr outflow tract (RVOT) reconstruction in truncus arteriosus repair (1).

In their manuscript the Authors report on 15 patients (range, 28 days to 21 months) successfully operated upon for primary correction of truncus arteriosus associated with RVOT reconstruction by means of a bicuspidized valved conduit obtained by a conventional homograft (pulmonary = 14, aortic = 1) after one cusp resection. For the bicuspidized pulmonary homograft cohort, the reported in-hospital mortality was 20% (3/15), with a 5-year survival and a 5-year freedom from reoperation of 100%, respectively.

Benjacholamas and co-workers should be congratulated for their excellent results. The reported technique however, was not first introduced by Michler and colleagues (2), as mentioned in the manuscript, but by our group. Indeed, in 1993 in the July issue of the Journal of Cardiac Surgery we first reported on how to reduce the diameter of oversized homografts, in our series harvested from the heart of transplant recipients, making them suitable for correction of complex congenital heart disease in small children (3). At the beginning of our experience, extensively reported in several instances in the middle nineties literature (4–6) and counting now overall more than 20 implants, the bicuspid homografts were used for repair of tetralogy of Fallot with pulmonary atresia in 2 patients and for reconstruction of the left ventricular outflow tract in a patient with anatomically corrected transposition of the great arteries and pulmonary stenosis, with no mortality and excellent mid-term results.

Considering the demonstrated superiority of allograft over synthetic prostheses in the pediatric population and the ineluctability of subsequent replacement of conduits inserted in neonates or infants in the span of few years, indeed the reported technique represents a therapeutic option providing a conduit with excellent mid-term functional results when an appropriate-sized allograft is unavailable.

We understand that the motivating factors to choose this option may be shared by different surgical teams, but we also believe our group should be given the credit for its formal introduction.

REFERENCES

  1. Benjacholamas V, Namchaisiri J, Khongphatthanayothin A, Lertsapchroen P. Bicuspidized pulmonary homograft for truncus arteriousus repair. Asian Cardiovasc Thoracic Ann 2008;16:189–93.

  2. Michler RE, Chen JM, Quaegebeur JM. Novel technique for extending the use of allograft in cardiac operation. Ann Thorac Surg 1994;57:83–7.[Abstract/Free Full Text]

  3. Santini F, Faggian G, Chiominto B, Bertolini P, Stellin G, Mazzucco A. Application of fresh and cryopreserved homografts harvested from transplant patients for correction of complex congenital heart disease. J Card Surg 1993;8:453–8.[Medline]

  4. Santini F, Mazzucco A. Bicuspid homograft reconstruction of the right ventricular outflow tract in infants. Ann Thorac Surg 1995;60:S624–5.[Medline]

  5. Santini F, Prioli A, Pessotto R, Mazzucco A. Use of oversized homografts for right ventricular outflow tract reconstruction in infants. J Heart Valve Dis 1995;4:192–5.[Medline]

  6. Santini F, Prioli A, Rossetti L, Consolaro G, Mazzucco A. Usefulness of bicuspid homograft reconstruction of the right ventricular outflow tract in infants with complex congenital heart disease. Am J Cardiol 1997;80:1377–9.[Medline]

Asian Cardiovasc Thorac Ann 2009; 17:112
© 2009 by SAGE Publications
DOI: 10.1177/0218492309102642



This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
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Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Francesco Santini
Mariassunta Telesca
Giuseppe Faggian
Alessandro Mazzucco
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Santini, F.
Right arrow Articles by Mazzucco, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Santini, F.
Right arrow Articles by Mazzucco, A.

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