Abstract 19936: The Use of Decellularized Allografts for Pulmonary Valve Replacement Reduces Reoperation Rate in Children and Young Adults.
Introduction: Graft degeneration is a major cause of reoperation in young patients after pulmonary valve replacement. Glutaraldehyde fixed or cryopreserved grafts lack the potential to growth. Here we present the mid-term results of implantation of fresh decellularized pulmonary homografts (DPH) compared to glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts (CH).
Methods and Results: Thirty-seven patients with DPH in pulmonary position were consecutively evaluated during the follow-up (up to 5 years) including medical examination, echocardiography and MRI. These patients were matched according to age and pathology and compared to BJV (n=34) and CH (n=56) recipients. In contrast to BJV and CH groups, echocardiography revealed no increase of transvalvular gradient, cusp thickening or graft degeneration and normal ventricular function in DPH group during the entire follow-up. Over time, DPH valve annulus diameters converged towards normal z values. Five-year-freedom from explantation was 100% for DPH; 93 ± 4% and 91 ± 4% for BJV and CH conduits respectively. MRI was performed in matched 17 recipients of DPH and 20 BJV with longer follow up (>2 years). Mean age of the patients was 12.7 ± 6.1 years old in DPH and 13.0 ± 3.0 in BJV, with a follow-up time of 3.7 ± 1.0 and 2.7 ± 0.9 years respectively. Despite lower implantation age and longer observation time, the mean transvalvular gradient was significantly lower in DPH group (11mmHg) comparing to BJV group (23.2 mmHg; see Figure 1). Regurgitation fraction was 14% ± 3 and 4% ± 5 in DPH and BJV group respectively. In 3 DPH recipients moderate regurgitation was documented postoperatively and remained unchanged during the entire follow-up.
Conclusion: Decellularized fresh allograft valves showed superior performance comparing to conventional homografts and xenografts and exhibited increased durability, graft remodelling and adaptive growth.
- © 2010 by American Heart Association, Inc.