Ross Operation with decellularized pulmonary allografts: medium-term results

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• The Ross Operation is a surgical procedure to replace a diseased aortic valve with the patient's own pulmonary valve.
• Decellularized allografts offer a potential alternative to cryopreserved allografts, aiming to reduce immunogenicity and improve tissue integration.
• Medium-term outcomes of decellularized allografts in the Ross Operation require further evaluation.

Purpose of the Study:

• To assess the medium-term (4-year) clinical outcomes of decellularized allografts utilized in the Ross Operation.
• To compare the hemodynamic performance and structural integrity of decellularized allografts against cryopreserved allografts.

Main Methods:

• A cohort of 68 patients undergoing Ross Operation with decellularized allografts (decellularized with deoxycholic acid or sodium dodecylsulfate) were followed for 4 years.
• Hemodynamic data was collected via echocardiography, with comparisons made to a matched cohort receiving cryopreserved allografts.
• Histological analysis and MRI studies were performed to evaluate tissue regeneration and conduit characteristics.

Main Results:

• One early death (1.4%) and two late reoperations for endocarditis were reported. No progressive pulmonary insufficiency was observed.
• Echocardiography showed stable pressure gradients over time, with no significant difference compared to cryopreserved allografts, although a trend towards lower gradients was noted in the sodium dodecylsulfate group after 12 months.
• Histology confirmed partial reendothelialization and cellular repopulation, while MRI indicated a reduced tendency for shrinkage in decellularized conduits.

Conclusions:

• Decellularized allografts are safe for the Ross Operation, yielding favorable medium-term results up to 4 years.
• Sodium dodecylsulfate decellularized allografts may offer an advantage with potentially lower late pressure gradients.