ALLOGRAFT RECONSTRUCTION OF THE RIGHT-VENTRICULAR OUTFLOW TRACT

Objective. Evaluation of allograft reconstruction of the right ventric ular outflow tract (RVOT). Methods. From 1986 to April 1995, 201 allog rafts (146 pulmonary, 55 aortic) were implanted in 189 patients for co nduit reconstruction of the RVOT in congenital heart disease or in the pulmonary autograft procedure. The mean age at allograft implantation was 16 years (range 2 weeks - 54 years). The primary diagnoses of the se patients were truncus arteriosus (n = 19, 10%), transposition of th e great arteries (TGA) with ventricular Septal defect (VSD) and pulmon ary atresia (PA) or stenosis (PS) (n = 14, 7%), PA with VSD (n = 26, 1 4%), PA or PS with intact septum (n = 7, 4%), tetralogy of Fallot (n = 44, 23%), corrected TGA with PA or PS (n = 11, 6%), tricuspid atresia (n = 9, 5%), aortic valve pathology for pulmonary autograft procedure (n = 55, 29%), and miscellaneous (n = 4, 2%), The allograft implantat ion was a reoperation in 54 patients (29%). Results. The mean follow-u p was 2.5 years (range 4 weeks-9 years). Six patients died in hospital (3.2%). Patient survival at 5 years was 91% (95% CL 86-95%). Freedom from all valve-related events (2 deaths, 17 reoperations, one endocard itis), as determined during reoperation or autopsy at 5 years was 78% (95% CL 65-86%). Freedom from structural allograft failure was 83% (2 deaths, 12 reoperations, 95% CL 70-90%). Allografts implanted for cong enital right heart defects failed earlier than allografts used for pul monary autograft procedures (P = 0.05). Aortic allografts showed struc tural failure more often than pulmonary allografts (P = 0.05). There w ere more valve-related events in patients of a younger age at implanta tion (P = 0.02) and in those allograft valves from younger donors (P = 0.004). Conclusions. Allograft RVOT reconstruction is an adequate sur gical therapy. The allograft should preferably be pulmonary. A younger age at implantation is a risk factor for allograft failure. Donor age may be a thus-far underestimated risk factor for allograft degenerati on.