Fresh decellularized pulmonary homografts achieved 100% 5-year freedom from explantation versus 86% for bovine jugular veins and 88% for cryopreserved homografts in pulmonary valve replacement.
Cohort (n=114)
Does fresh decellularized pulmonary homograft implantation improve freedom from explantation and hemodynamics compared with bovine jugular vein and cryopreserved homografts in children and young adults requiring pulmonary valve replacement?
Fresh decellularized pulmonary homografts for pulmonary valve replacement in young patients demonstrate excellent 5-year freedom from explantation and favorable hemodynamics compared to conventional grafts.
Absolute Event Rate: 100% vs 86%
BACKGROUND: Degeneration of xenografts or homografts is a major cause for reoperation in young patients after pulmonary valve replacement. We present the early results of fresh decellularized pulmonary homografts (DPH) implantation compared with glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts (CH). METHODS AND RESULTS: Thirty-eight 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 with BJV (n=38) and CH (n=38) recipients. In contrast to BJV and CH groups, echocardiography revealed no increase of transvalvular gradient, cusp thickening, or aneurysmatic dilatation in DPH patients. Over time, DPH valve annulus diameters converge toward normal z-values. Five-year freedom from explantation was 100% for DPH and 86 ± 8% and 88 ± 7% for BJV and CH conduits, respectively. Additionally, MRI investigations in 17 DPH patients with follow-up time >2 years were compared with MRI data of 20 BJV recipients. Both patient groups (DPH and BJV) were at comparable ages (mean, 12.7 ± 6.1 versus 13.0 ± 3.0 years) and have comparable follow-up time (3.7 ± 1.0 versus 2.7 ± 0.9 years). In DPH patients, the mean transvalvular gradient was significantly (P=0.001) lower (11 mm Hg) compared with the BJV group (23.2 mm Hg). Regurgitation fraction was 14 ± 3% and 4 ± 5% in DPH and BJV groups, respectively. In 3 DPH recipients, moderate regurgitation was documented after surgery and remained unchanged in follow-up. CONCLUSIONS: In contrast to conventional homografts and xenografts, decellularized fresh allograft valves showed improved freedom from explantation, provided low gradients in follow-up, and exhibited adaptive growth.
Cebotari et al. (Mon,) conducted a cohort in Pulmonary valve replacement (n=114). Fresh decellularized pulmonary homografts (DPH) vs. Glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts (CH) was evaluated on Five-year freedom from explantation. Fresh decellularized pulmonary homografts achieved 100% 5-year freedom from explantation versus 86% for bovine jugular veins and 88% for cryopreserved homografts in pulmonary valve replacement.