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Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes
BACKGROUND: The ideal conduit for repair of the right ventricular outflow tract (RVOT) during the Ross procedure remains unclear and has yet to be fully elucidated. We perform a pairwise meta-analysis to compare the short-term and long-term outcomes of decellularized versus cryopreserved pulmonary a...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572935/ https://www.ncbi.nlm.nih.gov/pubmed/34746974 http://dx.doi.org/10.1186/s43044-021-00226-w |
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author | Ahmed, Adham Ahmed, Sarah Varghese, Kathryn S. Mathew, Dave M. Pandey, Roshan Rogando, Dillon O. Salazar, Stephanie A. Fusco, Peter J. Levy, Kenneth H. |
author_facet | Ahmed, Adham Ahmed, Sarah Varghese, Kathryn S. Mathew, Dave M. Pandey, Roshan Rogando, Dillon O. Salazar, Stephanie A. Fusco, Peter J. Levy, Kenneth H. |
author_sort | Ahmed, Adham |
collection | PubMed |
description | BACKGROUND: The ideal conduit for repair of the right ventricular outflow tract (RVOT) during the Ross procedure remains unclear and has yet to be fully elucidated. We perform a pairwise meta-analysis to compare the short-term and long-term outcomes of decellularized versus cryopreserved pulmonary allografts for RVOT reconstruction during the Ross procedure. MAIN BODY: After a comprehensive literature search, studies comparing decellularized and cryopreserved allografts for patients undergoing RVOT reconstruction during the Ross procedure were pooled to perform a pairwise meta-analysis using the random-effects model. Primary outcomes were early mortality and follow-up allograft dysfunction. Secondary outcomes were reintervention rates and follow-up endocarditis. A total of 4 studies including 1687 patients undergoing RVOT reconstruction during the Ross procedure were included. A total of 812 patients received a decellularized pulmonary allograft, while 875 received a cryopreserved pulmonary allograft. Compared to cryopreserved allografts, the decellularized group showed similar rates of early mortality (odds ratio, 0.55, 95% confidence interval, 0.21–1.41, P = 0.22). At a mean follow-up period of 5.89 years, no significant difference was observed between the two groups for follow-up allograft dysfunction (hazard ratio, 0.65, 95% confidence interval, 0.20–2.14, P = 0.48). Similarly, no difference was seen in reintervention rates (hazard ratio, 0.54, 95% confidence interval, 0.09–3.12, P = 0.49) nor endocarditis (hazard ratio, 0.30, 95% confidence interval, 0.07–1.35, P = 0.12) at a mean follow-up of 4.85 and 5.75 years, respectively. CONCLUSIONS: Decellularized and cryopreserved pulmonary allografts are associated with similar postoperative outcomes for RVOT reconstruction during the Ross procedure. Larger propensity-matched and randomized control trials are necessary to elucidate the efficacy of decellularized allografts compared to cryopreserved allografts in the setting of the Ross. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43044-021-00226-w. |
format | Online Article Text |
id | pubmed-8572935 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-85729352021-11-17 Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes Ahmed, Adham Ahmed, Sarah Varghese, Kathryn S. Mathew, Dave M. Pandey, Roshan Rogando, Dillon O. Salazar, Stephanie A. Fusco, Peter J. Levy, Kenneth H. Egypt Heart J Review BACKGROUND: The ideal conduit for repair of the right ventricular outflow tract (RVOT) during the Ross procedure remains unclear and has yet to be fully elucidated. We perform a pairwise meta-analysis to compare the short-term and long-term outcomes of decellularized versus cryopreserved pulmonary allografts for RVOT reconstruction during the Ross procedure. MAIN BODY: After a comprehensive literature search, studies comparing decellularized and cryopreserved allografts for patients undergoing RVOT reconstruction during the Ross procedure were pooled to perform a pairwise meta-analysis using the random-effects model. Primary outcomes were early mortality and follow-up allograft dysfunction. Secondary outcomes were reintervention rates and follow-up endocarditis. A total of 4 studies including 1687 patients undergoing RVOT reconstruction during the Ross procedure were included. A total of 812 patients received a decellularized pulmonary allograft, while 875 received a cryopreserved pulmonary allograft. Compared to cryopreserved allografts, the decellularized group showed similar rates of early mortality (odds ratio, 0.55, 95% confidence interval, 0.21–1.41, P = 0.22). At a mean follow-up period of 5.89 years, no significant difference was observed between the two groups for follow-up allograft dysfunction (hazard ratio, 0.65, 95% confidence interval, 0.20–2.14, P = 0.48). Similarly, no difference was seen in reintervention rates (hazard ratio, 0.54, 95% confidence interval, 0.09–3.12, P = 0.49) nor endocarditis (hazard ratio, 0.30, 95% confidence interval, 0.07–1.35, P = 0.12) at a mean follow-up of 4.85 and 5.75 years, respectively. CONCLUSIONS: Decellularized and cryopreserved pulmonary allografts are associated with similar postoperative outcomes for RVOT reconstruction during the Ross procedure. Larger propensity-matched and randomized control trials are necessary to elucidate the efficacy of decellularized allografts compared to cryopreserved allografts in the setting of the Ross. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43044-021-00226-w. Springer Berlin Heidelberg 2021-11-07 /pmc/articles/PMC8572935/ /pubmed/34746974 http://dx.doi.org/10.1186/s43044-021-00226-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Review Ahmed, Adham Ahmed, Sarah Varghese, Kathryn S. Mathew, Dave M. Pandey, Roshan Rogando, Dillon O. Salazar, Stephanie A. Fusco, Peter J. Levy, Kenneth H. Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes |
title | Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes |
title_full | Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes |
title_fullStr | Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes |
title_full_unstemmed | Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes |
title_short | Decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a meta-analysis of short- and long-term outcomes |
title_sort | decellularized versus cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the ross procedure: a meta-analysis of short- and long-term outcomes |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572935/ https://www.ncbi.nlm.nih.gov/pubmed/34746974 http://dx.doi.org/10.1186/s43044-021-00226-w |
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