How long can the next intervention be delayed after balloon dilatation of homograft in the pulmonary position?

Background and Objectives: We investigated the effectiveness of balloon dilatation of homograf conduits in the pulmonary position in delaying surgical replacement. Subjects and Methods: We reviewed the medical records of patients who underwent balloon dilatation of their homograf in the pulmonary position from 2001 to 2015. The pressure gradient and ratio of right ventricular pressure were measured before and afer the procedure. The primary goal of this study was to evaluate the parameters associated with the interval to next surgical or catheter intervention. Results: Twenty-eight balloon dilations were performed in 26 patients. The median ages of patients with homograf insertion and balloon dilatation were 20.3 months and 4.5 years, respectively. The origins of the homografs were the aorta (53.6%), pulmonary artery (32.1%), and femoral vein (14.3%). The median interval afer conduit implantation was 26.7 months. The mean ratio of balloon to graf size was 0.87. The pressure gradient through the homograf and the ratio of right ventricle to aorta pressure were signifcantly improved afer balloon dilatation (p<0.001). There were no adverse events during the procedure with the exception of one case of balloon rupture. The median interval to next intervention was 12.9 months. The median interval of freedom from re-intervention was 16.6 months. Cox proportional hazards analysis revealed that the interval of freedom from re-intervention differed only according to origin of the homograf (p=0.032), with the pulmonary artery having the longest interval of freedom from re-intervention (p=0.043). Conclusion: Balloon dilatation of homografs in the pulmonary position can be safely performed, and homografs of the pulmonary artery are associated with a longer interval to re-intervention.