Decellularized Versus Standard Cryopreserved Homografts for Pulmonary Valve Replacement in the Ross Procedure

The optimal right ventricular outflow tract (RVOT) conduit in the Ross procedure remains controversial. This study addresses outcomes of decellularized (DH) and cryopreserved homografts (CH) for RVOT reconstruction. Patients aged 8 years or older who underwent the Ross procedure using DH or CH were reviewed. Conduit durability and pulmonary valve function were compared between both groups. A total of 59 patients were included (26 DH-patients and 33 CH-patients). The median age at Ross procedure (DH: 19 (IQR: 13-30) vs. CH: 15 (IQR: 12-23) years, p = 0.150) and the homograft diameters (DH: 24 (22-26) vs. CH: 23 (22-24) mm, p = 0.163) were similar between the groups. When comparing postoperative events within the first 5 years between the groups, none of the DH-patients experienced infective endocarditis, homograft explantation, or catheter intervention. Whereas, in the CH group, 2 patients developed infective endocarditis, 2 underwent explantation, and one underwent Melody implantation. Following up with serial echocardiography for up to 5 years, none of the DH-patients developed significant pulmonary stenosis (PS > 40 mmHg), and one patient developed significant pulmonary regurgitation (PR: moderate or worse). In contrast, 2 patients in the CH group demonstrated significant PS, and 5 patients showed significant PR. Freedom from graft dysfunction, defined by endocarditis, explantation, Melody implantation, significant PS, and significant PR, tended to be better in DH than CH (90.9% vs. 79.0% at 5 years, p = 0.155). Our results demonstrated better short-term valve performance with DH than with CH following the RVOT reconstruction during the Ross procedure.