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DOI: 10.1055/s-0033-1354466
Decellularized Fresh Pulmonary Valved Homografts in Pulmonary Position: Experience with 71 Patients Observed in Total for 250 Years, Up to 8 Years
Background: Homografts have limited durability and degenerate early especially in young patients. After encouraging experience with a small series in pulmonary position, we began to implant decellularized fresh pulmonary homografts (DPH) in lager quantities.
Patients and Methods: From 2002 to 2013, 72 DPHs were implanted. 554 postoperative examinations took place. Patient age: mean 15.3 ± 10.2 years (0.1 to 50.9, median 31.7) with 2 patients < 1 year, 7 from 1 to 5 and 14 from 5 to 10 years. Total follow- up is 252 years. Findings were collected preoperatively following a standardised protocol. 39 (55%) were Fallot-patients, 9 (13%) had a Ross procedure, 23 (32%) other congenital malformations.
Results: One non conduit related early death occurred. At 8 years, no homograft was explanted, 1 balloon dilatation was performed (freedom from intervention: 97.2 ± 2.7%). We saw no endocarditis. Freedom from moderate insufficiency (7 patients) was 89.7 ± 3.7%. Freedom from stenosis (peak gradient ≥50 mm Hg, 5 patients) was 88.6 ± 5.1%. Freedom from degeneration (any of the above events, 12 patients) was 76.5 ± 6.5%. Being above or below 10 years of age did not influence the degeneration risk.
Conclusion: We continue to consider decellularized fresh pulmonary valved homografts the device of choice in case of need for a pulmonary valved conduit.