Femoral vein homograft for neoaortic reconstruction in the Norwood stage 1 operation: A follow-up study

Abstract

The aim of this study was to analyze our experience with the cryopreserved femoral vein homograft in comparison with standard biomaterials for neoaortic reconstruction in the Norwood stage 1 operation. All patients who underwent the Norwood operation from September 2004 to April 2011 were analyzed retrospectively (n = 107). Patients were grouped into group A (cryopreserved femoral vein homograft; n = 72) or group B (other; n = 35). Intergroup comparisons and dimensional analyses of all available angiograms were performed. Two surgical techniques, "standard homograft cuff" and "homograft tube," were compared. Multivariable Cox regression analysis revealed use of biomaterial other than femoral vein (P = .01; hazard ratio, 3.0; 95% confidence interval [CI], 1.4-6.4), weight less than 2.5 kg at the time of stage 1 (P = .01; hazard ratio, 3.7; 95% CI, 1.7-7.8), and need for extracorporeal membrane oxygenator support after stage 1 (P < .001; hazard ratio, 13.8; 95% CI, 5.9-31.9) as significant independent predictors of overall mortality. Improved late survival at 48 months was seen with the femoral vein homograft compared with other biomaterials when a "homograft tube with end-to-side ascending aortic reimplantation technique" was used (group A [75%] vs group B [44%]; P = .03). With the use of the "homograft cuff technique," survival was similar for femoral vein homografts and other biomaterials (group A [67%] vs group B [61%]; P = .85). Similar neoaortic coarctation rates were seen in both groups (A: 25/59 [42%] vs B: 12/26 [46%]; P = .81). A progressive increase in the diameter of the neoaorta was seen over time in both groups with both technical modifications (tube grafts pre-stage 2 vs pre-stage 3: group A [10.61 mm ± 1.93 vs 13.74 mm ± 3.16] [P < .001] and group B [13.93 mm ± 6.71 vs 17.38 mm ± 5.92] [P = .049]); cuff repair pre-stage 2 to pre-stage 3: group A [13.98 mm ± 2.13 vs 19.09 mm ± 4.18] [P = .002] and group B [16.06 mm ± 3.05 vs 19.73 mm ± 2.93] [P < .001]). The neoaortic Z-scores were generous with the use of homograft cuffs and modest when homograft tubes were used and maintained in range over the follow-up time. Survivals are improved with the use of femoral vein homograft for neoaortic reconstruction for Norwood stage 1 operation, especially when used as a homograft tube with end-to-side aortic reimplantation. Femoral vein homografts have similar recoarctation rates compared with standard biomaterials. Progressive growth/dilation of the neoaorta in proportion to somatic growth is seen with femoral vein tube grafts.