Paediatric aortic valve replacement using decellularized allografts.
Allografts
Aortic valve disease
Children
Decellularization
Journal
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
ISSN: 1873-734X
Titre abrégé: Eur J Cardiothorac Surg
Pays: Germany
ID NLM: 8804069
Informations de publication
Date de publication:
01 10 2020
01 10 2020
Historique:
received:
09
11
2019
revised:
04
03
2020
accepted:
10
03
2020
pubmed:
23
5
2020
medline:
22
6
2021
entrez:
23
5
2020
Statut:
ppublish
Résumé
Options for paediatric aortic valve replacement (AVR) are limited if valve repair is not feasible. Results of paediatric Ross procedures are inferior to adult Ross results, and mechanical AVR imposes constant anticoagulation with the inherent risks. The study design was a prospective, multicentre follow-up of all paediatric patients receiving decellularized aortic homografts (DAHs) for AVR in 8 European centres. A total of 106 children (77 boys) were operated (mean age 10.1 ± 4.8 years, DAH diameter 20.5 ± 3.8 mm). A total of 60 (57%) had undergone previous surgical interventions: 34 with 1, 15 with 2 and 11 with ≥3. There was one early death in a 12-year-old girl, who underwent her fourth aortic valve operation, due to intracerebral haemorrhage on extracorporeal membrane oxygenation after coronary reimplantation problems following 3-sinus reconstruction 1 year earlier. One 2-year-old patient died due to sepsis 2 months postoperatively with no evidence for endocarditis. In addition, a single pacemaker implantation was necessary and a 2.5-year-old girl underwent successful HTx due to chronic myocardial failure despite an intact DAH. After a mean follow-up of 3.30 ± 2.45 years, primary efficacy end points mean peak gradient (18.1 ± 20.9 mmHg) and regurgitation (mean 0.61 ± 0.63, grade 0-3) were very good. Freedom from death/explantation/endocarditis/bleeding/stroke at 5 years was 97.8 ± 1.6/85.0 ± 7.4/100/100/100% respectively. Calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.9 years), lower than in Ross patients (9.4 years) and in the same range as mechanical AVR (12.8 years). Even though the overall number of paediatric DAH patients and the follow-up time span are still limited, our data suggest that DAHs may present a promising additional option for paediatric AVR.
Identifiants
pubmed: 32443152
pii: 5842228
doi: 10.1093/ejcts/ezaa119
pmc: PMC7890932
doi:
Types de publication
Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
817-824Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
Références
Interact Cardiovasc Thorac Surg. 2019 Jan 1;28(1):151-157
pubmed: 30016427
J Thorac Cardiovasc Surg. 2019 Jan;157(1):201-208
pubmed: 30104067
J Am Coll Cardiol. 2016 Jun 21;67(24):2858-70
pubmed: 27311525
Ann Thorac Surg. 2019 Aug;108(2):581-589
pubmed: 30928547
Ann Thorac Surg. 2015 Dec;100(6):2278-84
pubmed: 26603019
J Thorac Cardiovasc Surg. 2016 Oct;152(4):1202-3
pubmed: 27269183
J Thorac Cardiovasc Surg. 2016 Jan;151(1):143-52.e1-3
pubmed: 26541831
Ann Thorac Surg. 2015 May;99(5):1601-8; discussion 1608-9
pubmed: 25754965
Circ Cardiovasc Qual Outcomes. 2018 Dec;11(12):e004748
pubmed: 30562065
J Thorac Cardiovasc Surg. 2016 Oct;152(4):1197-9
pubmed: 27131847
Ann Thorac Surg. 2019 Aug;108(2):544-551
pubmed: 31075247
Eur J Cardiothorac Surg. 2016 Jul;50(1):89-97
pubmed: 26896320
Thromb Haemost. 2019 Feb;119(2):189-190
pubmed: 30620992
J Am Coll Cardiol. 2016 Jun 21;67(24):2871-3
pubmed: 27311526
Eur J Cardiothorac Surg. 2019 Sep 1;56(3):503-509
pubmed: 30879050
J Biomed Mater Res A. 2017 Jan;105(1):138-147
pubmed: 27601305
Circulation. 2014 Jul 1;130(1):51-60
pubmed: 24756063
Ann Thorac Surg. 2016 May;101(5):1804-10
pubmed: 27041455
Ann Thorac Surg. 2010 Dec;90(6):1854-60
pubmed: 21095325
Circulation. 2019 Feb 12;139(7):983-985
pubmed: 30742533
Eur Heart J. 2017 Dec 1;38(45):3370-3377
pubmed: 29045647