Paediatric aortic valve replacement using decellularized allografts: a multicentre update following 143 implantations and five-year mean follow-up

European Journal of Cardio-Thoracic Surgery, vol. 65

Abstract

OBJECTIVES: Decellularized aortic homografts (DAH) were introduced in 2008 as a further option for paediatric aortic valve replacement (AVR). METHODS: Prospective, multicentre follow-up of all paediatric patients receiving DAH for AVR in 8 European centres. RESULTS: A total of 143 DAH were implanted between February 2008 and February 2023 in 137 children (106 male, 74%) with a median age of 10.8 years (interquartile range 6.6-14.6). Eighty-four (59%) had undergone previous cardiac operations and 24 (17%) had undergone previous AVR. The median implanted DAH diameter was 21 mm (interquartile range 19-23). The median operation duration was 348 min (227-439) with a median cardiopulmonary bypass time of 212 min (171-257) and a median cross-clamp time of 135 min (113-164). After a median follow-up of 5.3 years (3.3-7.2, max. 15.2 years), the primary efficacy end-points peak gradient (median 14 mmHg, 9-28) and regurgitation (median 0.5, interquartile range 0-1, grade 0-3) showed good results but an increase over time. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 5 years were 97.8 ± 1.2/88.7 ± 3.3/99.1 ± 0.9/100 and 99.2 ± 0.8%, respectively. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 10 years were 96.3 ± 1.9/67.1 ± 8.0/93.6 ± 3.9/98.6 ± 1.4 and 86.9 ± 11.6%, respectively. In total, 21 DAH were explanted. Seven were replaced by a mechanical AVR, 1 Ross operation was performed and a re-do DAH was implanted in 13 patients with no redo mortality. The calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.4 years), and in the same range as for Ross patients (9.2 years) and mechanical AVR (13.0 years). CONCLUSIONS: This large-scale prospective analysis demonstrates excellent mid-term survival using DAH with adverse event rates comparable to paediatric Ross procedures.

Authors 20

1. Alexander Horke

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany

2. Dmitry Bobylev

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany

3. Murat Avsar

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany

4. Tomislav Cvitkovic

   Medizinische Hochschule Hannover

   Affiliation as printed

   Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany

5. Bart P. Meyns

   KU Leuven

   Affiliation as printed

   Department of Cardiac Surgery, Katholieke Universiteit Leuven , Belgium

6. Filip Rega

   KU Leuven

   Affiliation as printed

   Department of Cardiac Surgery, Katholieke Universiteit Leuven , Belgium

7. Mark Gerard Hazekamp Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, Leiden University Medical Center , Netherlands

8. Robert Anton Cesnjevar

   University Children's Hospital Zurich

   Affiliation as printed

   Division of Congenital Cardiovascular Surgery, University Children’s Hospital , Zurich, Switzerland

9. Martin Schmiady

   University Children's Hospital Zurich

   Affiliation as printed

   Division of Congenital Cardiovascular Surgery, University Children’s Hospital , Zurich, Switzerland

10. Brigitte Staebler

    Sana Kliniken AG

    Affiliation as printed

    Department of Cardiac Surgery, Sana Herzchirurgie , Stuttgart, Germany

11. Oliver Dewald

    Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

    Affiliation as printed

    Division of Pediatric Cardiac Surgery, University of Erlangen , Erlangen, Germany

12. Anatol Ciubotaru

    Nicolae Testemițanu State University of Medicine and Pharmacy

    Affiliation as printed

    Cardiac Surgery Center, State Medical and Pharmaceutical University , Chisinau, Moldova

13. Ina Michel‐Behnke

    Medical University of Vienna

    Affiliation as printed

    Department of Pediatric Cardiology, Medical University of Vienna , Austria

14. Daniel Zimpfer

    Medical University of Vienna

    Affiliation as printed

    Department of Cardiac Surgery, Medical University of Vienna , Austria

    Department of Cardiac Surgery, Medical University of Vienna, Austria, Medical University of Vienna, Austria

15. Ramadan Jashari

    Clinique Saint Jean

    Affiliation as printed

    European Homograft Bank, Clinique Saint-Jean , Brussels, Belgium

16. Dietmar Boethig

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany

    Department for Pediatric Cardiology and Intensive Care, Hannover Medical School , Germany

17. Serghei Cebotari
    Affiliation as printed

    Department of Cardiac Surgery, Institute for Cardiac Surgery and Interventional Cardiology , Luxembourg, Luxembourg

18. Philipp Beerbaum

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department for Pediatric Cardiology and Intensive Care, Hannover Medical School , Germany

    Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Germany

19. I. Tudorache

    Medizinische Hochschule Hannover

    Affiliation as printed

    Clinic for Cardiac Surgery, University Heart Center Zurich , Zurich, Switzerland

    Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany

20. Samir Sarikouch corresponding

    Medizinische Hochschule Hannover

    Affiliation as printed

    Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , Hannover, Germany