Allograft implantation in pediatric cardiac surgery: surgical experience from 1982 to 1994.
Between July 1982 and April 1994, a total of 290 patients (median age 6.5 years, range 1 month to 32.1 years, 69 patients younger than 1 year) underwent repair of their cardiac malformation by insertion of an allograft. The diagnoses were truncus arteriosus communis (n = 78, 27.0%), tetralogy of Fallot (n = 59, 20.0%), pulmonary atresia (n = 72, 25.0%), double outlet right ventricle (n = 15, 5.0%), complex transposition of the great arteries plus pulmonary stenosis (n = 37, 13.0%), and others (n = 29, 10.0%). Either pulmonary (n = 69) or aortic (n = 221) cadaver allografts were implanted. Two hundred twenty-nine of the allografts were antibiotic preserved. Since January 1991 (n = 61), a new cryopreservation procedure was employed for standardized uniform cooling using heat sinks and defined package geometry. Follow-up was complete for 95.2% (n = 276, 1,320 patient-years). Thirty-day mortality was 9.0% (n = 26) and late mortality was 12.1% (n = 35). Kaplan-Meier analysis revealed that patient survival was determined mainly by their underlying cardiac disease. All allografts with valve sizes less than 15.0 mm had to be exchanged within 7 years as these patients had outgrown their conduits. When the allograft was larger than 15.0 mm, exchange was necessary in 20% at 10 years. ABO compatibility and aortic or pulmonary origin of the allograft were not significant influences on allograft survival.(ABSTRACT TRUNCATED AT 250 WORDS)
Weipert
J
J
Department for Cardiovascular Surgery, German Heart Center Munich.
Meisner
H
H
Mendler
N
N
Haehnel
J C
JC
Homann
M
M
Paek
S U
SU
Sebening
F
F
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents; D001021:Aortic Valve / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D005500:Follow-Up Studies; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D016019:Survival Analysis; D014021:Tissue Preservation; D014184:Transplantation, Homologous / Q000401:mortality
D000900:Anti-Bacterial Agents