Ten year experience with pulmonary allografts in children

Infants who have undergone pulmonary valve allograft reconstruction of the right ventricular outflow tract experience an increased incidence of allograft fibrocalcification and valvar insufficiency compared to older allograft recipients. Since April 1985, 186 cryopreserved pulmonary valve allografts have been used for right ventricular outflow tract reconstruction in pediatric patients at The Children's Hospital and the University of Colorado Health Sciences Center in Denver. One hundred and forty-six patients were one to 18.4 years of age (mean age: 5.0 years) and 40 children were younger than one year of age at operation (mean age: 4.4 months). In the older patient group, there were 15 hospital deaths (10%) and one child with dilated cardiomyopathy and cardiac failure underwent cardiac transplantation two days postoperatively. One hundred and thirty operative survivors have been followed clinically for a mean of 4.6 years. One child was lost to follow up and one patient with myocardial dysfunction required cardiac transplant 3.8 years postoperatively. There have been five late deaths (4%), one of which resulted from accidental trauma. Five children (4%) have undergone reoperation to replace their valve allograft at 1.3 to 9.8 years after the initial allograft procedure. In the infant group, there were nine hospital deaths (23%). During follow up averaging 3.0 years, there have been nine late deaths (29%) and five children (16%) have undergone valve allograft explant 2.0 months to 3.5 years following implantation. Allografts are technically desirable in small children for whom surgical repair alternatives are limited.(ABSTRACT TRUNCATED AT 250 WORDS)