From the Guidelines
Homografts in valved conduits refer to the use of human heart tissue, including valves and attached blood vessels, harvested from deceased donors to replace damaged heart structures in another person, particularly in reconstructive heart surgeries. When considering the use of homografts in valved conduits, it's essential to weigh the benefits and drawbacks. The advantages of homografts include excellent hemodynamic properties, no need for lifelong anticoagulation therapy, resistance to infection, and the ability to grow with pediatric patients 1. However, homografts may eventually calcify or deteriorate over time, potentially requiring replacement after 10-20 years. Some key points to consider when using homografts in valved conduits include:
- The use of cryopreservation techniques to diminish the rate of structural valve deterioration 1
- The potential for reoperation after homograft AVR to be more difficult than reoperation after placement of standard prostheses 1
- The excellent hemodynamic efficiency of homografts, even in small sizes 1
- The low risk of thromboembolism after homograft implantation 1 It's crucial to carefully evaluate the individual patient's needs and circumstances when deciding whether to use a homograft in a valved conduit, taking into account factors such as age, overall health, and the specific cardiac condition being treated. The use of homografts in valved conduits can be a valuable option for patients undergoing reconstructive heart surgeries, particularly in cases where a functional valve and section of blood vessel are needed to replace complex cardiac structures.
From the Research
Homografts in Valved Conduits
- Homografts are used in valved conduits to correct blood flow in congenital heart disease by connecting the right ventricle to the pulmonary artery (RV-PA) 2.
- Valved conduits, including homografts, have been used in pediatric cardiac surgery since 1966, with both aortic and pulmonary homografts being utilized 3.
- The use of homograft valved conduits has several benefits, including the ability to provide a valved connection between the right ventricle and pulmonary arteries in children with certain congenital heart defects 4.
Applications of Homograft Valved Conduits
- Homograft valved conduits are used in various cardiac surgery procedures, including the Ross operation and reconstruction of the outflow tract of the right ventricle 5, 4.
- They are also used in patients with endocarditis, congenital defects, and women who wish to become pregnant 6.
- The use of homograft valved conduits has been shown to have satisfactory results, with a freedom of re-infection rate of 91.9% +/- 3.6% after 15 years 6.
Limitations and Future Directions
- Homograft valved conduits have limited biocompatibility and durability, and lack additional growth capacity 2.
- Decellularized valved conduits have been proposed as an effective improved method, which can reduce immune response and calcification, and has potential growth ability 2.
- Tissue engineering artificial valved conduits are also being developed, but require further study 2.