Abstract
Right ventricular outflow tract reconstruction (RVOTR) with cryopreserved allograft for Ross operation and other congenital or acquired cardiac malformation has become a routine and currently, the procedure of choice for children and young patients. A tendency of accelerated degeneration in the youngest recipients has been reported. Some authors advocate the ABO group incompatibility as the main reason for such failure. This retrospective monocentric study presents the long-term outcome of the European Homograft Bank (EHB) cryopreserved allografts, used for RVOTR in Ross operation (group one) and other congenital heart malformation-s (group two). The evaluation of the allograft performance was done by means of echography, considering the allografts with the transvalvular gradient of ≥40 mm Hg and/or regurgitation of ≥3+ as failed. Fifty-one patients of group one and 123 of group two were analysed after completed follow-up information. About 25.5% of patients of group one and 30.8% of group two had a compatible, whereas 74.5% of group one and 68.92 of group two an incompatible ABO group with the donor. The mean follow up was 45.77 and 68.88 months, respectively. In second group 22.76% received the aortic, while 77.24% pulmonary allograft. Only three cases of group one (5.88%) failed: one with a compatible (7.69%) and two with an incompatible ABO group (5.26%) (p = 0.1), whereas 39 patients (29.4%) of group two failed between 20.1 and 120.2 months (29.73% with and 29.07% without ABO compatibility, p = 0.03). Contrary, the age showed more importance in the allograft failure: out of 41 failed allografts, 24 (58.54%) were implanted in patients of 0–5 years (9 or 37.5% with compatible and 15 or 62.5% with incompatible ABO group). Generally, analysing both groups together, there was no influence of ABO mismatching on the allograft failure (p = 0.79). Contrary, there was a significant difference in survival between Ross and non-Ross group (p = 0.00082).
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References
Bando K., Danielson G. K. and Scha. H. V. et al. 1995. Out-come of pulmonary and aortic homografts for right ventric-ular out. ow tract reconstruction. J. Thorac. Cardiovasc. Surg. 109: 509–518.
Barrat-Boyes B. 1964. Homograft aortic valve replacement in aortic incompetence and stenosis. Thorax 19: 131.
Baskett R. J., Ross D. B., Nanton M. A. and Murphy D. A. 1996. Factors in the early failure of cryopreserved homograft pulmonary valves in children: preserved immunogenicity. J. Thorac. Cardiovasc. Surg. 112: 1170–1179.
Christenson J. T., Vala D. and Sierra J. et al. 2003. Blood group incompatibility and accelerated homograft brocalci cations. 83rd Annual Meeting AATS, Boston May 4–7, 2003.
Clarke D. R., Campbell D. N., Hayward A. R. and Bishop D. A. 1993. Degeneration of aortic valve allograft in young recip-ients. J. Thorac. Cardiovasc. Surg. 105(5): 934–941.
Go. n Y., Grandmougin D. and Van Hoeck B. 1996. Banking cryopreserved heart valves in Europe: assessment of a 5-year operation in an international tissue bank in Brussels. Eur. J. Cardiothorac. Surg. 10: 505–512.
Hawkins J. A., Bailey W. W., Dillon T. and Schwartz D. C. 1992. Midterm results with cryopreserved allograft valved conduits from the right ventricle to the pulmonary arteries. J. Thorac. Cardiovasc. Surg. 104: 910–916.
Kadner A., Chen A. H., Mitchell R. N. and Adams D. H. 2001. Homograft crossmatching is unnecessary due to the absence of blood group antigens. Ann. Thorac. Surg. 71: S349–S352.
Lange R., Meipert J., Homann M., Mendler N., Paek S.-U., Holper K. and Meisner H. 2001. Performance of allografts and xenografts for right ventricular out. ow tract recon-struction. Ann. Thorac. Surg. 71: S365–S367.
O' Brian M. F., Sta. ord E. G., Gradner M. A. H. and Pohlner P. G. et al. 1987. A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with note on chromosomal studies. J. Thorac. Cardiovasc. Surg. 94: 812–823.
Rajani B., Mee R. B. and Ratli. N. B. 1998. Evidence of rejec-tion of homograft cardiac valves in infants. J. Thorac. Car diovasc. Surg. 115(1): 111–117.
Ross D. N. 1962. Homograft replacement of aortic valve. Lancet 2: 487.
Santini F., Piccin C., Prioli A., Pessoto R. and Mazzucco A. 1996. Accelerated allograft bro calci cation after right ventricular out. ow tract reconstruction in paediatric patients: report of two cases. Eur. J. Cardiothorac. Surg. 10: 290–293.
Sugimoto J. T. and Krap R. B. 1987. Homografts and cryopre-served valves. In: Crawford F. A. (ed.), Current Heart Valve Prostheses. Cardiac Surgery 1: 2 February, 1987, pp. 295–315.
Tweddell J. S., Pelech A. N. and Frommelt P. C. et al. 2000. Factors a. ecting longevity of homograft valves used in right ventricular out. ow tract reconstruction for congenital heart disease. Circulation 102(S3): III 130–135.
Yankah A. C., Wottge H. U. and Muller-Hermelink H. K. et al. 1987. Transplantation of aortic and pulmonary allografts, enhanced viability of endothelial cells by cryopreservation, importance of hystocompatibility. J. Card. Surg. 1(Suppl): 209–220.
Yankah A. C., Alexi-Meskhishvili V. and Weng Y. et al. 1995. Accelerated degeneration of allografts in the rst two years of life. Ann. Thorac. Surg. 60(2 Suppl): 71–76.
Yankah A. C. and Wottge H. U. 1997. Allograft conduit calci-cation in a model of chronic arterial allograft rejection. J. Card. Surg. 12(2): 86–92.
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Jashari, R., Daenen, W., Meyns, B. et al. Is ABO group incompatibility really the reason of accelerated failure of cryopreserved allografts in very young patients? – Echography assessment of the European Homograft Bank (EHB) cryopreserved allografts used for reconstruction of the right ventricular outflow tract* . Cell Tissue Banking 5, 253–259 (2004). https://doi.org/10.1007/s10561-004-1442-z
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DOI: https://doi.org/10.1007/s10561-004-1442-z