Use of fresh decellularized allografts for pulmonary valve replacement may reduce the reoperation rate in children and young adults: early report

Circulation. 2011 Sep 13;124(11 Suppl):S115-23. doi: 10.1161/CIRCULATIONAHA.110.012161.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Animals
  • Cardiac Surgical Procedures / methods*
  • Cardiac Surgical Procedures / statistics & numerical data
  • Cattle
  • Child
  • Child, Preschool
  • Cryopreservation*
  • Echocardiography
  • Follow-Up Studies
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / pathology
  • Heart Valve Diseases / surgery*
  • Humans
  • Jugular Veins / transplantation*
  • Magnetic Resonance Imaging
  • Male
  • Pulmonary Valve / diagnostic imaging
  • Pulmonary Valve / pathology
  • Pulmonary Valve / surgery*
  • Reoperation / statistics & numerical data
  • Transplantation, Heterologous
  • Transplantation, Homologous
  • Treatment Outcome
  • Young Adult