Decellularized Versus Standard Pulmonary Allografts in the Ross Procedure: Propensity-Matched Analysis

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Transplantation Immunology

Background:

• Right ventricular outflow tract reconstruction often utilizes allografts.
• Decellularization of allografts is hypothesized to reduce valve deterioration.
• This study compares decellularized allografts (DA) with cryopreserved allografts (SCA) in the Ross procedure.

Purpose of the Study:

• To compare the durability and clinical outcomes of decellularized pulmonary allografts versus standard cryopreserved pulmonary allografts.
• To evaluate the early and midterm performance of allografts in patients undergoing the Ross procedure.

Main Methods:

• 144 patients received DA (2005-2014) and 619 received SCA (1990-2014) for the Ross procedure.
• Propensity score matching was employed to create comparable groups for analysis.
• Clinical outcomes and echocardiographic allograft function were assessed over time.

Main Results:

• 94 DA patients were matched to 94 SCA patients with similar baseline characteristics.
• No significant differences were observed in 5-year freedom from allograft dysfunction, reintervention, survival, or event-free survival between DA and SCA groups.
• Both groups demonstrated comparable, modest increases in allograft gradient and regurgitation over time.

Conclusions:

• Decellularized allografts (DA) and standard cryopreserved allografts (SCA) demonstrate similar excellent clinical and hemodynamic outcomes up to 5 years post-Ross procedure.
• Further long-term follow-up and dedicated echocardiographic studies are needed to fully elucidate the performance of decellularized allografts.