Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and xenografts

• Published in: European journal of cardio-thoracic surgery 2000-06, Vol.17 (6), p.624-630
• Main Authors: Homann, Michael, Haehnel, John Cristoph, Mendler, Nikolaus, Paek, Sung Un, Holper, Klaus, Meisner, Hans, Lange, Rüdiger
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Allograft; Biological and medical sciences; Biological heart valves; Bioprosthesis; Child; Child, Preschool; Female; Graft Rejection; Graft Survival; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - surgery; Heart Septal Defects - diagnosis; Heart Septal Defects - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Heart Ventricles - abnormalities; Humans; Infant; Infant, Newborn; Male; Medical sciences; Prognosis; Pulmonary Valve - abnormalities; Pulmonary Valve - surgery; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Transplantation, Heterologous; Transplantation, Homologous; Xenograft
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(00)00414-0

Objective: The reconstruction of the RVOT in congenital heart disease often requires the implantation of a valved conduit. Although allografts are considered the conduit of choice their availability is limited and therefore xenografts are implanted as well. We compared the long-term durability of both grafts in the RVOT over a 25-year period. Methods: Between January 1974 and August 1999, 505 patients (median age 4.0 years, range 2 days–31 years; median weight 14.5 kg, range 2.2–76.6 kg; median body length 103 cm, range 48–183 cm) with congenital malformations (PA 25.3%, TOF 14.5%, TOF+PA 2.4%, DORV 4.2%, TGA+PS 8.7%, TAC 24.8%, and other 20.2%) received their first valved conduit (174 xenografts: median diameter 14 mm, range 8–27 mm; 331 allografts: median diameter 19 mm, range 8–30 mm). Results: Follow-up is 3017 patient-years. The 10-year survival-probability for all patients. was 66% with a mean reoperation-free interval for conduit-exchange of 13.3 years (mean reoperation-free interval for allografts, 16.0 years; mean reoperation-free interval for xenograft, 10.3 years). One hundred and thirteen patients underwent a conduit-exchange, mostly due to conduit stenosis. Fourteen patients had a second exchange and three patients a third exchange. For patients with conduit diameters ≪18 mm (n=235: allograft n=116, xenograft n=119; median age 9 months, range 0–27.3 years), the mean reoperation-free interval was 11.2 years (mean interval allograft, 13.1 years; mean interval xenograft, 8.6 years, P=0.03). For conduit diameters ≥18 mm (n=270: allograft n=215, xenograft n=55, median age 7.4 years, range 0–34.3 years) the mean interval from freedom of conduit exchange was 15.1 years (for allografts 14.1 years, for xenografts 12.5 years, P≪0.01). Comparing xenografts to allografts, we found no difference in patient survival probability (P=0.62). There was no significant difference between antibiotic (n=198) preserved vs. cryopreserved (n=133) allografts (P=0.06). Blood group compatibility of allografts to recipients had no significant influence on allograft function (P=0.42). The donors allograft origin, whether aortic or pulmonary valve, had also no significant influence on allograft long-term function (P=0.15). Conclusion: For the reconstruction of the right ventricular outflow tract (RVOT) allografts show significantly better long-term durability than xenografts regardless of the age at implantation and the diameter.