Pulmonary homografts are used more frequently in cardiac surgery. They are used primarily for reconstruction of the right ventricular outflow tract, both in children with complex congenital disease and in adults undergoing the Ross procedure for aortic valve replacement. They have been used for left ventricular outflow tract reconstruction, but they are less durable in this high-pressure position. They have excellent hemodynamic characteristics, require no anticoagulation, and are free from problems of thromboembolism. However, there is concern that over time pulmonary homografts may develop stenosis secondary to low-grade immune reactions. Even as they become more popular, a shortage of available grafts may limit their use.
Department of Surgery, Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Correspondence to Lawrence J. Dacey, MD, Department of Surgery, Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA