title: Use of fresh decellularized allografts for pulmonary valve replacement may reduce the reoperation rate in children and young adults: early report.
abstract: 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).
  
  
  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.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. cebotari.serghei@mh-hannover.de
authors.forename: Serghei
authors.initials: S
authors.lastname: Cebotari
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.forename: Anatol
authors.initials: A
authors.lastname: Ciubotaru
authors.forename: Dietmar
authors.initials: D
authors.lastname: Boethig
authors.forename: Samir
authors.initials: S
authors.lastname: Sarikouch
authors.forename: Adelheid
authors.initials: A
authors.lastname: Goerler
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
authors.forename: Eduard
authors.initials: E
authors.lastname: Cheptanaru
authors.forename: Sergiu
authors.initials: S
authors.lastname: Barnaciuc
authors.forename: Anatol
authors.initials: A
authors.lastname: Cazacu
authors.forename: Oxana
authors.initials: O
authors.lastname: Maliga
authors.forename: Oleg
authors.initials: O
authors.lastname: Repin
authors.forename: Liviu
authors.initials: L
authors.lastname: Maniuc
authors.forename: Thomas
authors.initials: T
authors.lastname: Breymann
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D002417:Cattle; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D004452:Echocardiography; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000637:transplantation*; D008279:Magnetic Resonance Imaging; D008297:Male; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult