Pulmonary Allograft Extension with Decellularized Human Pericardium Improves Hemodynamic Function after the Ross Operation
Francisco D A Costa1, Angelo Cabral1, Claudinei Colatusso1, Eduardo M. Balbi Filho1, Rafael Torres1, Gabriela M. Schorn1, Joao Gabriel Roderjan2, Paula H. Suss2.
1INC Cardio, Curitiba, Brazil, 2PUCPR, Curitiba, Brazil.
OBJECTIVE: Compare the hemodynamic performance of decellularized pulmonary allografts with and without decellularized pericardium extension during the Ross Operation.
METHODS: Between 2005 and 2017, 194 patients were submitted to a Ross Operation with decellularized allografts. One hundred and fifty five had the allograft implanted in the conventional manner (Group Conventional) and in 39 the allografts had a proximal extension with a circular patch of decellularized human pericardium (Group Extended). Follow-up included annual clinical and echocardiographic control studies. CT scans were also performed to analyze allograft diameters and calcification. Hemodynamic performance was compared after propensity matching the two groups in a 2:1 fashion (Conventional =78, Extended=39).
RESULTS: After propensity matching, patients had similar baseline characteristics, with a mean age of 30 years in both groups. Freedom from a peak gradient > 40mmHg was 100% versus 93% (p=0.15) at five years in the extended versus the conventional group, respectively. Freedom from ≥ moderate allograft insufficiency was 96% and 95% (p=0.7) for the extended and conventional groups, respectively. Longitudinal echocardiographic analysis demonstrated significantly lower peak gradients in the extended group at all time intervals up to five years of follow-up. At 5 years, the mean of peak gradients was 11.6 mmHg versus 17.6 mmHg in the extended and the conventional group, respectively. CT scans, performed in 18 patients in the extended group revealed normal allografts diameter, absence of calcification in both the allograft and in the pericardium extension, with no dilatation or calcification of the circular patch up to five years.
CONCLUSIONS: Extension of decellularized pulmonary allografts with decellularized human pericardium was associated with significantly improved hemodynamics and lower peak gradients when compared to the conventionally implanted decellularized allografts. Although longer follow-up is still necessary, this technique may optimize RVOT reconstruction during the Ross Operation and avoid the need for future reinterventions.
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