Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children

Costa, Francisco Diniz Affonso da; Etnel, Jonathan R.G.; Torres, R. R. A.; Filho, Eduardo Mendel Balbi; Torres, Rafael A.; Calixto, Allyson; Mulinari, Leonardo

doi:10.1177/2150135117723916

Cited by 26 publications

(21 citation statements)

References 26 publications

(75 reference statements)

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“…2,3,6,25 However, freedom from conduit failure in our cohorts still worse than reported for decellularized homografts. [25][26][27] The main cause of conduit failure was stenosis in both groups, which corresponds to results of the other studies. 3,4,12,28,29 Conduit valve regurgitation accompanied stenosis in 13.8%.…”

Section: Commentsupporting

confidence: 89%

“…However, it was only moderate and could not be the main cause of conduit failure, as reported for bovine jugular vein grafts and homografts. 5,26,30 In the DE-PVC group, proximal stenosis of the xenograft due to calcification of the walls and leaflets was the most typical. In the GA-PVC group, distal stenosis occurred more often and caused by neointimal proliferation.…”

Section: Commentmentioning

confidence: 99%

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Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children

Nichay

Zhuravleva

Kulyabin

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Xenografts used for right ventricular outflow tract (RVOT) reconstruction are typically treated with glutaraldehyde. However, potential benefit of epoxy treatment was demonstrated in experimental studies. We aimed to compare diepoxy-treated bovine pericardial valved conduits (DE-PVCs) and glutaraldehyde-treated bovine pericardial valved conduits (GA-PVCs) for RVOT reconstruction in pediatric patients. Methods: Between 2002 and 2017, 117 patients underwent RVOT reconstruction with PVC in single center: DE-PVC group, n = 39; and GA-PVC group, n = 78. After performing propensity score analysis (1:1) for the entire sample, 29 patients from the DE-PVC group were matched with 29 patients from the GA-PVC group. Results: There were no conduit-related deaths. In the DE-PVC group, the freedom from conduit failure was 90.9% at four years and 54.3% at eight years postoperatively. In the GA-PVC group, it was 46.3% and 33.1%, respectively. The difference was significant ( P = .037). Conduit failure was typically caused by stenosis in both groups. In the DE-PVC group, the main cause of stenosis was xenograft calcification (27.6%); while in the GA-PVC group, it was mostly due to neointimal proliferation (25.0%) and, less often, calcification (14.3%). Conduit thrombosis was the cause of replacement in 6.9% of patients from the GA-PVC group. Conclusions: Diepoxy-treated bovine pericardial valved conduit is a suitable alternative to GA-PVC for RVOT reconstruction in pediatric patients. Diepoxy-treated bovine pericardial valved conduits may be less prone to conduit failure and more resistant to neointimal proliferation and conduit thrombosis than GA-PVCs.

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Section: Commentsupporting

confidence: 89%

Section: Commentmentioning

confidence: 99%

Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children

Nichay

Zhuravleva

Kulyabin

et al. 2019

World J Pediatr Congenit Heart Surg

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“…On the other hand, the da Costa’s group also showed excellent results in a retrospective analysis of the use of their established proprietary decellularization protocol in paediatric patients. Freedom from reintervention at 10 years for children below 12 years of age was a remarkable 91% [10].…”

Section: Introductionmentioning

confidence: 99%

A European study on decellularized homografts for pulmonary valve replacement: initial results from the prospective ESPOIR Trial and ESPOIR Registry data†

Boethig

Horke

Hazekamp

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Decellularized pulmonary homografts (DPH) have shown excellent results for pulmonary valve replacement. However, controlled multicentre studies are lacking to date. METHODS Prospective European multicentre trial evaluating DPH for pulmonary valve replacement. Matched comparison of DPH to bovine jugular vein (BJV) conduits and cryopreserved homografts (CH) considering patient age, type of heart defect and previous procedures. RESULTS In total, 121 patients (59 female) were prospectively enrolled (August 2014–December 2016), age 21.3 ± 14.4 years, DPH diameter 24.4 ± 2.8 mm. No adverse events occurred with respect to surgical handling; there were 2 early deaths (30 + 59 years) due to myocardial failure after multi-valve procedures and no late mortality (1.7% mortality). After a mean follow-up of 2.2 ± 0.6 years, the primary efficacy end points mean peak gradient (16.1 ± 12.1 mmHg) and regurgitation (mean 0.25 ± 0.48, grade 0–3) were excellent. One reoperation was required for recurrent subvalvular stenosis caused by a pericardial patch and 1 balloon dilatation was performed on a previously stented LPA. 100% follow-up for DPH patients operated before or outside the trial (n = 114) included in the ESPOIR Registry, age 16.6 ± 10.4 years, diameter 24.1 ± 4.2 mm, follow-up 5.1 ± 3.0 years. The combined DPH cohort, n = 235, comprising both Trial and Registry data showed significantly better freedom from explantation (DPH 96.7 ± 2.1%, CH 84.4 ± 3.2%, P = 0.029 and BJV 82.7 ± 3.2%, P = 0.012) and less structural valve degeneration at 10 years when matched to CH, n = 235 and BJV, n = 235 (DPH 61.4 ± 6.6%, CH 39.9 ± 4.4%, n.s., BJV 47.5 ± 4.5%, P = 0.029). CONCLUSIONS: Initial results of the prospective multicentre ESPOIR Trial showed DPH to be safe and efficient. Current DPH results including Registry data were superior to BJV and CH. Trial registration clinicaltrials.gov identifier: NCT 02035540.

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“…Excellent results were achieved after the Ross operation with good freedom from reoperation and excellent hemodynamics at long‐term follow‐up 3 . However, the majority of patients implanted with cryopreserved homografts develop antibodies against HLA, specific for the transplanted tissue 4,5 . Considering that the main target patient population undergoing valve replacement with human allografts are children or young adults, in whom later heart transplantation may be necessary, a significant humoral response against valve tissue is a matter of concern.…”

Section: Introductionmentioning

confidence: 99%

“…3 However, the majority of patients implanted with cryopreserved homografts develop antibodies against HLA, specific for the transplanted tissue. 4,5 Considering that the main target patient population undergoing valve replacement with human allografts are children or young adults, in whom later heart transplantation may be necessary, a significant humoral response against valve tissue is a matter of concern. The use of decellularized human valve allografts during the last decade intended to overcome this limitation, avoiding a vigorous immune response.…”

mentioning

confidence: 99%

Donor‐specific HLA antibodies after fresh decellularized vs cryopreserved native allograft implantation

Coti

Wenda

Андреева

et al. 2020

HLA

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This study aims to compare the immunogenicity of fresh decellularized with cryopreserved native heart valve allografts to identify potential immunological risks in subsequent organ transplantations. We measured the induction of allogeneic HLA class I and II specific antibodies and characterized donor-specific antibodies by Luminex-based single beads assay in both groups. Serum samples were collected before valve replacement, at 3 and 24 months postoperatively. Donorspecific HLA antibodies were assessed positive if the mean fluorescent intensity (MFI) was >1000. Between November 2016 and April 2017 patients with fresh decellularized homografts (n = 4) and cryopreserved native homografts (n = 4) were analyzed. Patients receiving cryopreserved native allografts reacted with broad HLA-specific antibody response. Antibodies were directed against mismatched HLA antigens of the donors but also against HLA specificities not present on the homograft with many antibodies having mean fluorescence intensity values >10 000. While HLA class I specific antibodies showed a significant increase (P = .002) in their MFI values on day 90, HLA class II specific antibodies did not show a significant increase (P = .069). In the fresh decellularized homografts group, no significant antibody induction was observed. Consequently, the native group presented significantly higher MFIs for HLA antibodies on day 90 compared with the patients receiving decellularized allografts (P = .021). No detectable HLA antibody response was observed after implantation of decellularized in comparison with cryopreserved native allografts. Lower immunogenicity as compared with native homografts might increase the chance of receiving a transplant if will be required later in the life of the patients. K E Y W O R D S cryopreserved native allografts, donor-specific HLA antibodies, fresh decellularized allografts 1 | INTRODUCTION Aortic or pulmonary valve replacement or a Ross procedure with human homografts may be required because of the lack of alternatives in children and young adult patients. The use of cryopreserved human allografts offered better long-term results in terms of valve hemodynamics and long-term freedom of reoperation, as well

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Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children

Cited by 26 publications

References 26 publications

Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children

Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children

A European study on decellularized homografts for pulmonary valve replacement: initial results from the prospective ESPOIR Trial and ESPOIR Registry data†

Donor‐specific HLA antibodies after fresh decellularized vs cryopreserved native allograft implantation

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