Fresh decellularized versus standard cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a propensity-matched study

OBJECTIVES: Recent studies have shown favourable early results with decellularized allografts (DAs) for right ventricular outflow tract reconstruction during the Ross procedure. However, mid- and long-term outcome data are still scarce. The objective of this study was to compare the durability of fresh DAs with standard cryopreserved allografts (SCAs) in patients undergoing the Ross procedure. METHODS: Two hundred patients underwent the Ross procedure with DA and 202 with SCA. Using propensity score matching, mid- and long-term clinical outcome and echocardiographic allograft function over time were compared. RESULTS: One hundred and thirty DA patients (median age 28 years, 71.5% men, mean follow-up 4.2 +/- 2.6 years) were matched with 130 SCA patients (median age 30 years, 69.2% men, mean follow-up 13 +/- 4.5 years). After matching, there were no differences in baseline characteristics. In the matched DA vs SCA groups, actuarial 8-year freedom from allograft dysfunction (DA = 86.7% vs SCA = 87.3%, P = 0.183) and freedom from allograft reintervention (DA = 99.2% vs SCA = 97.6%, P = 0.642) were comparable. Longitudinal echocardiographic analyses showed a significantly lower progression rate of peak right ventricular outflow tract gradients in the DA group during the first 3 years after the operation. Absolute gradients over time were slightly lower in DA when compared with SCA, although 95% confidence intervals overlapped. CONCLUSIONS: Up to 8 years of follow-up, DA and SCA used for right ventricular outflow tract reconstruction in the Ross procedure are associated with comparably excellent clinical and haemodynamic outcome. Longer follow-up and dedicated echocardiographic studies are still necessary to confirm the long-term performance of the DAs.