Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and xenografts

Objective: The reconstruction of the RVOT in congenital heart disease often requires the implantation of a valved conduit. Although allografts are considered the conduit of choice their availability is limited and therefore xenografts are implanted as well. We compared the long-term durability of both grafts in the RVOT over a 25-year period. Methods: Between January 1974 and August 1999, 505 patients (median age 4.0 years, range 2 days-31 years; median weight 14.5 kg, range 2.2-76.6 kg; median body length 103 cm, range 48-183 cm) with congenital malformations (PA 25.3%, TOF 14.5%, TOF + PA 2.4%, DORV 4.2%, TGA + PS 8.7%, TAC 24.8%, and other 20.2%) received their first valved conduit (174 xenagrafts: median diameter 14 mm, range 8-27 mm; 331 allografts: median diameter 19 mm, range 8-30 mm). Results: Follow-up is 3017 patient-years. The 10-year survival-probability for all patients, was 66% with a mean reoperation-free interval for conduit-exchange of 13.3 years (mean reoperation-free interval for allografts, 16.0 years; mean reoperation-free interval for xenograft, 10.3 years). One hundred and thirteen patients underwent a conduit-exchange, mostly due to conduit stenosis. Fourteen patients had a second exchange and three patients a third exchange. For patients with conduit diameters <18 mm (n = 235: allograft n = 116, xenograft n = 119; median age 9 months, range 0-27.3 years), the mean reoperation-free interval was 11.2 years (mean interval allograft, 13.1 years; mean interval xenograft, 8.6 years, P = 0.03). For conduit diameters greater than or equal to 18 mm (n = 270: allograft n = 215, xenograft n = 55, median age 7.4 years, range 0-34.3 years) the mean interval from freedom of conduit exchange was 15.1 years (for allografts 14.1 years, for xenografts 12.5 years, P < 0.01). Comparing xenografts to allografts, we found no difference in patient survival probability (P = 0.62). There was no significant difference between antibiotic (n = 198) preserved vs. cryopreserved (n = 133) allografts (P = 0.06). Blood group compatibility of allografts to recipients had no significant influence on allograft function (P = 0.42). The donors allograft origin, whether aortic or pulmonary valve, had also no significant influence on allograft long-term function (P = 0.15). Conclusion: For the reconstruction of the right ventricular outflow tract (RVOT) allografts show significantly better long-term durability than xenografts regardless of the age at implantation and the diameter. (C) 2000 Published by Elsevier Science B.V.