Results of using fresh decellularized allografts for pulmonary valve replacement

The OBJECTIVE was to perform a comparative analysis of the outcomes of using different types of fresh decellularized allografts in the pulmonary position.METHODS AND MATERIALS. The study was conducted at the Department of Surgery with the course of Cardiovascular Surgery of the Institute of Continuing Professional Education, Samara State Medical University, based at the V. P. Polyakov Samara Regional Clinical Cardiology Dispensary. This was a single-center retrospective comparative cohort study based on the experience of pulmonary valve replacement with fresh decellularized allografts in patients with congenital heart disease from 2008 to 2022. A total of 134 patients (72 males and 62 females) who met the inclusion criteria underwent 185 interventions on the pulmonary valve. Freedom from reintervention was assessed using the Kaplan–Meier method; intergroup differences were evaluated with the Mantel – Cox log-rank test. Statistical significance was set at p≤0.05.RESULTS. In the early postoperative period, all groups demonstrated a low rate of complications and 30-day mortality. During follow-up, redo valve replacement due to allograft dysfunction was required in 22 cases (11.9 %). Pulmonary allografts showed the best durability: the median freedom from reintervention was 156 months, compared with 95 months for aortic allografts and 10 months for venous allografts; the differences between the groups were statistically significant (p<0.001). Venous allografts were characterized by early calcification and a high need for reoperation during the first year of follow-up. In our cohort, older age at the time of surgery and larger conduit diameter were associated with longer allograft durability.CONCLUSION. Fresh decellularized pulmonary allografts demonstrated the best freedom from reintervention compared with aortic and, particularly, venous allografts and may be considered a preferred option for pulmonary valve replacement. Venous allografts in the pulmonary position were characterized by early dysfunction and a high need for reinterventions, which restricts their use as long-term valved conduits.