European Journal of Cardio-Thoracic Surgery, Vol 10, 609-614, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Allograft reconstruction of the right ventricular outflow tract
TP Willems, AJ Bogers, AH Cromme-Dijkhuis, EW Steyerberg, LA van Herwerden, RB Hokken, J Hess and E Bos
Department of Cardio-Pulmonary Surgery, University Hospital Sophia- Dijkzigt, Rotterdam, The Netherlands.
OBJECTIVE: Evaluation of allograft reconstruction of the right ventricular
outflow tract (RVOT). METHODS: From 1986 to April 1995, 201 allografts (146
pulmonary, 55 aortic) were implanted in 189 patients for conduit
reconstruction of the RVOT in congenital heart disease or in the pulmonary
autograft procedure. The mean age at allograft implantation was 16 years
(range 2 weeks - 54 years). The primary diagnoses of these patients were
truncus arterious (n = 19, 10%), transposition of the great arteries (TGA)
with ventricular septal defect (VSD) and pulmonary atresia (PA) or stenosis
(PS) (n = 14, 7%), PA with VSD (n = 26, 14%), PA or PS with 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%), and miscellaneous (n = 4, 2%).
The allograft implantation was a reoperation in 54 patients (29%). RESULTS:
The mean follow-up was 2.5 years (range 4 weeks-9 years). Six patients died
in hospital (3.2%). Patient survival at 5 years was 91% (95% CL 86-95%).
Freedom from all valve-related events (2 deaths, 17 reoperations, one
endocarditis), as determined during reoperation or autopsy at 5 years was
78% (95% CL 65-86%). Freedom from structural allograft failure was 83% (2
deaths, 12 reoperations, 95% CL 70-90%). Allografts implanted for
congenital right heart defects failed earlier than allografts used for
pulmonary autograft procedures (P = 0.05). Aortic allografts showed
structural failure more often than pulmonary allografts (P = 0.05). There
were more valve-related events in patients of a younger age at implantation
(P = 0.02) and in those allograft valves from younger donors (P = 0.004).
CONCLUSIONS: Allograft RVOT reconstruction is an adequate surgical therapy.
The allograft should preferably be pulmonary. A younger age at implantation
is a risk factor for allograft failure. Donor age may be a thus-far
underestimated risk factor for allograft degeneration.
