The outcome of antibiotic sterilised aortic homografts used in the Fontan procedure

Abstract

Between 1977 and 1988, 27 patients between the ages of 4 and 22 years(mean 8.9) underwent a Fontan procedure with the use of an antibiotic sterilised aortic homograft. There were 15 patients with tricuspid atresia,9 with univentricular heart and 3 others. The homograft was anastomosed toa right-sided pulmonary artery in ten, to a left-sided main pulmonaryartery in eight and in nine patients the homograft connected the rightatrium to the right ventricle. There were five early deaths (18.5%)unrelated to the homograft and two late deaths at 7 and 10 yearspostoperatively. Five patients have required removal of the calcifiedobstructed homograft with no death. In three patients patches wereinserted, but in two patients with good right ventricles a second homograftwas inserted. In three of the re-operated patients the homograft laydirectly behind the sternum and the femoral artery was exposed and in twoof them the femoral artery was cannulated before the chest was opened tocontrol haemorrhage. Of the patients 74% are alive up to 15 years later, 15with their original homograft. Eight (57%) of those still have theiroriginal homograft more than 10 years post- operatively.