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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 934-941, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DR Clarke, DN Campbell, AR Hayward and DA Bishop
Aortic allograft fibrocalcification and valvular insufficiency have been
observed in patients less than 3 years of age at initial replacement of the
left ventricular outflow tract. From June 1985 through May 1992, 47
children have undergone aortic root replacement with cryopreserved aortic
valve allografts. Thirty-three children were 3 years of age or older and 14
were less than 3 years of age at operation. In the older patient group,
there were three (9%) hospital deaths and one child underwent cardiac
transplantation 30 hours after aortic root replacement because of left
ventricular failure. Clinical follow-up of the 29 surviving older children
is from 4 months to 6.6 years (mean 3.0 years). One patient was lost to
follow-up. Two children (7%) have required reoperation, but primary
allograft degeneration was not observed. In the younger patient group,
there were three (21%) hospital deaths. Follow-up ranged from 2.5 months to
4.7 years (mean 2.3 years). Among 11 operative survivors, one late death
resulted from a pulmonary embolus. Seven of 10 (70%) remaining allograft
recipients had progressive allograft calcification or insufficiency. Six of
them have required reoperation to explant the allograft, and one child is
currently receiving cyclosporine therapy with the original valve allograft.
The cause of allograft failure is possibly immunologic. The prevalence of
early aortic valve allograft degeneration has prompted the consideration of
nonviable allografts or xenografts, pulmonary autografts, or minimal
immunosuppression as alternatives when left ventricular outflow tract
reconstruction is necessary in children less than 3 years of age.
ARTICLES
Degeneration of aortic valve allografts in young recipients
Childrens Hospital, Denver, Colo. 80218.
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