Decellularized Allografts For Rvot Reconstruction In Children - 12 Years Results Of A Multiinstitutional Experience
Francisco D. Costa1, Marcelo Jatene2, Leonardo Mianna2, Fernando Moraes3, Gabriela M. Schorn1, Myriam Wisniewski1, Leonardo Mulinari4.
1Hospital Infantil Pequeno Príncipe, Curitiba, Brazil, 2INCOR - SP, São Paulo, Brazil, 3Hospital Real Portugues, Recife, Brazil, 4Santa Casa de Curitiba PUCPR, Curitiba, Brazil.
Objective: Although cryopreserved allografts are considered the gold standard conduit for RVOT reconstruction, long-term results in children have been disappointing. Decellularized allografts are emerging as an alternative, but their outcomes in children are largely unknown. This study reports a 12-year multi-institutional experience with decellularized allografts for RVOT reconstruction in children. Methods: Between 2006 and 2018, 101 consecutive patients with congenital heart disease, mean age of 6.2 ± 3.8 years had RVOT reconstruction with decellularized allografts in three different institutions. The most common diagnosis was aortic valve disease (Ross operation) and Tetralogy of Fallot. Mean follow-up was 5.9 years (range 0.2 - 12) and was 95% complete. Besides routine echo evaluation, 20 patients with more than 5 years of follow-up were also submitted to CT scan evaluation. Structural valve dysfunction (SVD) was defined as a peak gradient > 40 mmHg or insufficiency > moderate. Results: Long-term survival was 91% at 10 years. There was no case of endocarditis. Three patients were submitted to reinterventions. Freedom from reintervention was 92% at 10 years. Mean early peak gradient was 14 mmHg and 29 mmHg at late follow-up. Nine patients had peak gradients > 40 mmHg and 16 had moderate or severe insufficiency. Overall, actuarial freedom from stenosis, insufficiency or any dysfunction was 77.6%, 65.6% and 57.8% at 10 years, respectively. Univariable analysis revealed younger age and smaller body surface area as risk factors for conduit dysfunction. By CT scan, there was minimal or absent calcification up to 10 years. Conclusions: Decellularized allografts presented favorable hemodynamics and acceptable incidence of SVD in the pediatric cohort. Absence of calcification in this age group is striking. Although these results need to be confirmed in larger series, decellularized allografts is emerging as an attractive alternative to the current available conduits for RVOT reconstruction in children.
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