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Fresh Decellularized Versus Standard Cryopreserved Pulmonary Allografts For Right Ventricular Outflow Reconstruction During The Ross Operation - Six Years Of Follow-up
Francisco D. da Costa, Ana Beatriz Brenner Affonso da Costa, Daniele Fornazari, Andrea Dumsch de Aragon Ferreira, Sergio Veiga Lopes, Marcia Olandoski, Tiago Fernandes, Claudinei Colatusso.
Santa Casa de Curitiba PUCPR, Curitiba, Brazil.

Objective: Evaluate the mid-term clinical and echocardiographic results of fresh decellularized versus cryopreserved pulmonary allografts for RVOT during the Ross operation.
Methods: Between October 2007 and July 2013, 126 Ross operations were performed using a fresh decellularized pulmonary valve allograft. For comparison, we reviewed data from 204 patients from our database that received a cryopreserved allograft. Conduit dysfunction was defined as any peak gradient greater than 40 mmHg or insufficiency grade III or IV. The influence of age, ABO compatibility and z-value of the implanted allograft were specifically analyzed. Comparisons were made with Kaplan Meier survival estimate, unbalanced two way repeated measures ANOVA and with linear regression analysis.
Results: Peak gradients at hospital discharge was similar between groups, but after the second year of follow-up late gradients were significantly lower for the fresh decellularized group (p = 0,001). Moderate or severe regurgitation was present in one case of the decellularized group and in five of the cryopreserved. Freedom from conduit dysfunction at 6 years was significantly better in the decellularized (97% - CL95%, 85-99%) versus the cryopreserved (85% - CL95%, 78-90%) group (p=0,014) at six years. There was no reoperation due to primary valve failure in the decellularized group, while two patients had reoperations for this reason in the cryopreserved group. In addition, decellularization eliminated age, ABO compatibility and allograft z-score as risk factors for the occurrence of elevated late gradients.
Conclusions: Fresh decellularized allografts were superior to conventional cryopreserved allografts for RVOT reconstruction during the Ross operation up to six years of follow-up, with lower late gradients, less pulmonary insufficiency and lower overall incidence of conduit dysfunction. 

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