Allograft reconstruction of the right ventricular outflow tract

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Abstract
OBJECTIVE: Evaluation of allograft reconstruction of the rightventricular outflow tract (RVOT). METHODS: From 1986 to April 1995, 201allografts (146 pulmonary, 55 aortic) were implanted in 189 patients forconduit reconstruction of the RVOT in congenital heart disease or in thepulmonary autograft procedure. The mean age at allograft implantation was16 years (range 2 weeks - 54 years). The primary diagnoses of thesepatients were truncus arterious (n = 19, 10%), transposition of the greatarteries (TGA) with ventricular septal defect (VSD) and pulmonary atresia(PA) or stenosis (PS) (n = 14, 7%), PA with VSD (n = 26, 14%), PA or PSwith intact septum (n = 7, 4%), tetralogy of Fallot (n = 44, 23%),corrected TGA with PA or PS (n = 11, 6%), tricuspid atresia (n = 9, 5%),aortic valve pathology for pulmonary autograft procedure (n = 55, 29%), andmiscellaneous (n = 4, 2%). The allograft implantation was a reoperation in54 patients (29%). RESULTS: The mean follow-up was 2.5 years (range 4weeks-9 years). Six patients died in hospital (3.2%). Patient survival at 5years was 91% (95% CL 86-95%). Freedom from all valve-related events (2deaths, 17 reoperations, one endocarditis), as determined duringreoperation or autopsy at 5 years was 78% (95% CL 65-86%). Freedom fromstructural allograft failure was 83% (2 deaths, 12 reoperations, 95% CL70-90%). Allografts implanted for congenital right heart defects failedearlier than allografts used for pulmonary autograft procedures (P = 0.05).Aortic allografts showed structural failure more often than pulmonaryallografts (P = 0.05). There were more valve-related events in patients ofa younger age at implantation (P = 0.02) and in those allograft valves fromyounger donors (P = 0.004). CONCLUSIONS: Allograft RVOT reconstruction isan adequate surgical therapy. The allograft should preferably be pulmonary.A younger age at implantation is a risk factor for allograft failure. Donorage may be a thus-far underestimated risk factor for allograftdegeneration.

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