ALLOGRAFT IMPLANTATION IN PEDIATRIC CARDIAC-SURGERY - SURGICAL EXPERIENCE FROM 1982 TO 1994

Between July 1982 and April 1994, a total of 290 patients (median age 6.5 years, range 1 month to 32.1 years, 69 patients younger than 1 yea r) underwent repair of their cardiac malformation by insertion of an a llograft. The diagnoses were truncus arteriosus communis (n = 78, 27.0 %), tetralogy of Fallot (n = 59, 20.0%), pulmonary atresia (n = 72,25. 0%), double outlet right ventricle (n = 15, 5.0%), complex transpositi on of the great arteries plus pulmonary stenosis (n = 37, 13.0%), and others (n = 29, 10.0%). Either pulmonary (n = 69) or aortic (n = 221) cadaver allografts were implanted. Two hundred twenty-nine of the allo grafts were antibiotic preserved. Since January 1991 (n = 61), a new c ryopreservation procedure was employed for standardized uniform coolin g using heat sinks and defined package geometry. Follow-up was complet e for 95.2% (n = 276, 1,320 patient-years). Thirty-day mortality was 9 .0% (n = 26) and late mortality was 12.1% (n = 35). Kaplan-Meier analy sis revealed that patient survival was determined mainly by their unde rlying cardiac disease. All allografts with valve sizes less than 15.0 mm had to be exchanged within 7 years as these patients had outgrown their conduits. When the allograft was larger than 15.0 mm, exchange w as necessary in 20% at 10 years. ABO compatibility and aortic or pulmo nary origin of the allograft were not significant influences on allogr aft survival. We conclude: (1) if it is possible to implant allografts with diameters greater than 15.0 mm, allografts of either pulmonary o r aortic origin are the grafts of choice for implantation into the rig ht ventricular outflow tract; and (2) allografts with diameters less t han 15.0 mm will require reoperation within 7 years. In these patients , xenograft implantation may be indicated.