{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T07:03:53Z","timestamp":1779692633477,"version":"3.53.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Deutsches Herzzentrum M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The optimal right ventricular outflow tract (RVOT) conduit in the Ross procedure remains controversial. This study addresses outcomes of decellularized (DH) and cryopreserved homografts (CH) for RVOT reconstruction. Patients aged 8 years or older who underwent the Ross procedure using DH or CH were reviewed. Conduit durability and pulmonary valve function were compared between both groups. A total of 59 patients were included (26 DH-patients and 33 CH-patients). The median age at Ross procedure (DH: 19 (IQR: 13\u201330) vs. CH: 15 (IQR: 12\u201323) years,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.150) and the homograft diameters (DH: 24 (22\u201326) vs. CH: 23 (22\u201324) mm,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.163) were similar between the groups. When comparing postoperative events within the first 5 years between the groups, none of the DH-patients experienced infective endocarditis, homograft explantation, or catheter intervention. Whereas, in the CH group, 2 patients developed infective endocarditis, 2 underwent explantation, and one underwent Melody implantation. Following up with serial echocardiography for up to 5 years, none of the DH-patients developed significant pulmonary stenosis (PS\u2009&gt;\u200940 mmHg), and one patient developed significant pulmonary regurgitation (PR: moderate or worse). In contrast, 2 patients in the CH group demonstrated significant PS, and 5 patients showed significant PR. Freedom from graft dysfunction, defined by endocarditis, explantation, Melody implantation, significant PS, and significant PR, tended to be better in DH than CH (90.9% vs. 79.0% at 5 years,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.155). Our results demonstrated better short-term valve performance with DH than with CH following the RVOT reconstruction during the Ross procedure.\n                  <\/jats:p>","DOI":"10.1007\/s00246-026-04312-1","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:17:55Z","timestamp":1779689875000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decellularized Versus Standard Cryopreserved Homografts for Pulmonary Valve Replacement in the Ross Procedure"],"prefix":"10.1007","author":[{"given":"Muneaki","family":"Matsubara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Scheichl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"Schaeffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Palm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ruda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Piber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Hager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Ewert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"H\u00f6rer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masamichi","family":"Ono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"issue":"6","key":"4312_CR1","first-page":"797","volume":"31","author":"DN Ross","year":"1969","unstructured":"Ross DN, Radley-Smith R, Somerville J (1969) Pulmonary autograft replacement for severe aortic valve disease. Br Heart J 31(6):797\u2013798","journal-title":"Br Heart J"},{"issue":"4","key":"4312_CR2","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1016\/j.athoracsur.2025.08.045","volume":"121","author":"V Shetty","year":"2026","unstructured":"Shetty V, Narayan P, Rao S et al (2026) The Ross Procedure in Young and Middle-Aged Patients: Long-Term Outcomes. Ann Thorac Surg 121(4):903\u2013911","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"4312_CR3","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/j.jtcvs.2025.10.042","volume":"171","author":"M Salem","year":"2026","unstructured":"Salem M, Y\u00f6r\u00fcker U, Valeske K et al (2026) Aortic remodeling and pulmonary autograft performance over 2 decades after the Ross procedure in the pediatric and young adult population. J Thorac Cardiovasc Surg 171(3):703-710.e5","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5","key":"4312_CR4","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1016\/j.jtcvs.2024.10.023","volume":"169","author":"KB Abeln","year":"2025","unstructured":"Abeln KB, Froede L, Giebels C, Sch\u00e4fers HJ (2025) Durability of right ventricular conduits in the Ross procedure. J Thorac Cardiovasc Surg 169(5):1306\u20131314","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"12 Suppl 1","key":"4312_CR5","doi-asserted-by":"publisher","first-page":"I16","DOI":"10.1161\/hc37t1.094545","volume":"104","author":"GS Carr-White","year":"2001","unstructured":"Carr-White GS, Kilner PJ, Hon JK et al (2001) Incidence, location, pathology, and significance of pulmonary homograft stenosis after the Ross operation. Circulation 104(12 Suppl 1):I16\u2013I20","journal-title":"Circulation"},{"issue":"2","key":"4312_CR6","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.jtcvs.2005.04.003","volume":"130","author":"ES Selamet Tierney","year":"2005","unstructured":"Selamet Tierney ES, Gersony WM, Altmann K et al (2005) Pulmonary position cryopreserved homografts: durability in pediatric Ross and non-Ross patients. J Thorac Cardiovasc Surg 130(2):282\u20136","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"5","key":"4312_CR7","doi-asserted-by":"publisher","first-page":"1607","DOI":"10.1016\/j.athoracsur.2008.07.005","volume":"86","author":"JW Brown","year":"2008","unstructured":"Brown JW, Ruzmetov M, Rodefeld MD et al (2008) Right ventricular outflow tract reconstruction in Ross patients: does the homograft fare better? Ann Thorac Surg 86(5):1607\u201312","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"4312_CR8","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/j.athoracsur.2008.10.093","volume":"87","author":"JO B\u00f6hm","year":"2009","unstructured":"B\u00f6hm JO, Hemmer W, Rein JG et al (2009) A single-institution experience with the Ross operation over 11 years. Ann Thorac Surg 87(2):514\u201320","journal-title":"Ann Thorac Surg"},{"issue":"5","key":"4312_CR9","first-page":"571","volume":"20","author":"D Kalfa","year":"2011","unstructured":"Kalfa D, Feier H, Loundou A et al (2011) Cryopreserved homograft in the Ross procedure: outcomes and prognostic factors. J Heart Valve Dis 20(5):571\u2013581","journal-title":"J Heart Valve Dis"},{"issue":"3","key":"4312_CR10","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/j.athoracsur.2022.05.017","volume":"115","author":"N El Sherif","year":"2023","unstructured":"El Sherif N, Dearani JA, Connolly HM et al (2023) Complexity and Outcome of Reoperations After the Ross Procedure in the Current Era. Ann Thorac Surg 115(3):633\u2013639","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"4312_CR11","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1016\/j.athoracsur.2017.09.057","volume":"105","author":"FDA da Costa","year":"2018","unstructured":"da Costa FDA, Etnel JRG, Charitos EI et al (2018) Decellularized versus standard pulmonary allografts in the Ross procedure: Propensity-matched analysis. Ann Thorac Surg 105(4):1205\u20131213","journal-title":"Ann Thorac Surg"},{"key":"4312_CR12","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.xjon.2025.01.020","volume":"25","author":"ABBADC R\u00e9a","year":"2025","unstructured":"R\u00e9a ABBADC, da Costa FDA, Adam EL et al (2025) Improving outcomes of right ventricular outflow tract reconstruction during the Ross operation: Homograft decellularization and surgical technique. JTCVS Open 25:25\u201338","journal-title":"JTCVS Open"},{"issue":"4","key":"4312_CR13","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1016\/j.jtcvs.2020.06.139","volume":"163","author":"V Chauvette","year":"2022","unstructured":"Chauvette V, Bouhout I, Tarabzoni M et al (2022) Pulmonary homograft dysfunction after the Ross procedure using decellularized homografts: a multicenter study. J Thorac Cardiovasc Surg 163(4):1296\u20131305","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"4312_CR14","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1093\/ejcts\/ezy079","volume":"54","author":"JRG Etnel","year":"2018","unstructured":"Etnel JRG, Suss PH, Schnorr GM et al (2018) Fresh decellularized versus standard cryopreserved pulmonary allografts for right ventricular outflow tract reconstruction during the Ross procedure: a propensity-matched study. Eur J Cardiothorac Surg 54(3):434\u2013440","journal-title":"Eur J Cardiothorac Surg"},{"issue":"3","key":"4312_CR15","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.athoracsur.2016.07.068","volume":"103","author":"S Bibevski","year":"2017","unstructured":"Bibevski S, Ruzmetov M, Fortuna RS et al (2017) Performance of SynerGraft decellularized pulmonary allografts compared with standard cryopreserved allografts: Results from multiinstitutional data. Ann Thorac Surg 103(3):869\u201374","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"4312_CR16","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/j.jtcvs.2011.12.032","volume":"143","author":"M Ruzmetov","year":"2012","unstructured":"Ruzmetov M, Shah JJ, Geiss DM et al (2012) Decellularized versus standard cryopreserved valve allografts for right ventricular outflow tract reconstruction: a single-institution comparison. J Thorac Cardiovasc Surg 143(3):543\u20139","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4312_CR17","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.1161\/CIRCULATIONAHA.110.012161","volume":"124","author":"S Cebotari","year":"2011","unstructured":"Cebotari S, Tudorache I, Ciubotaru A et al (2011) Use of fresh decellularized allografts for pulmonary valve replacement may reduce the reoperation rate in children and young adults: early report. Circulation 124:S115\u2013S123","journal-title":"Circulation"},{"issue":"5","key":"4312_CR18","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac219","volume":"62","author":"D Bobylev","year":"2022","unstructured":"Bobylev D, Horke A, Boethig D et al (2022) 5-year results from the prospective European multi-centre study on decellularized homografts for pulmonary valve replacement ESPOIR Trial and ESPOIR Registry data. Eur J Cardiothorac Surg 62(5):ezac219","journal-title":"Eur J Cardiothorac Surg"},{"issue":"3","key":"4312_CR19","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1093\/ejcts\/ezz054","volume":"56","author":"D Boethig","year":"2019","unstructured":"Boethig D, Horke A, Hazekamp M et al (2019) A European study on decellularized homografts for pulmonary valve replacement: initial results from the prospective ESPOIR Trial and ESPOIR Registry data. Eur J Cardiothorac Surg 56(3):503\u2013509","journal-title":"Eur J Cardiothorac Surg"},{"key":"4312_CR20","unstructured":"https:\/\/www.pei.de\/EN\/medicinal-products\/tissue-preparations\/heart-valves\/heart-valves-list.html, downloaded 2026-01-08"},{"issue":"2","key":"4312_CR21","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.athoracsur.2009.04.100","volume":"88","author":"J H\u00f6rer","year":"2009","unstructured":"H\u00f6rer J, Hanke T, Stierle U et al (2009) Homograft performance in children after the Ross operation. Ann Thorac Surg 88(2):609\u201315","journal-title":"Ann Thorac Surg"},{"key":"4312_CR22","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.echo.2010.03.019","volume":"23","author":"L Lopez","year":"2010","unstructured":"Lopez L, Colan SD, Frommelt PC et al (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23:465\u2013495","journal-title":"J Am Soc Echocardiogr"},{"issue":"5","key":"4312_CR23","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1111\/tan.14077","volume":"96","author":"I Coti","year":"2020","unstructured":"Coti I, Wenda S, Andreeva A et al (2020) Donor-specific HLA antibodies after fresh decellularized vs cryopreserved native allograft implantation. HLA 96(5):580\u2013588","journal-title":"HLA"},{"issue":"5\u20136","key":"4312_CR24","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1089\/ten.tea.2013.0316","volume":"20","author":"A Neumann","year":"2014","unstructured":"Neumann A, Sarikouch S, Breymann T et al (2014) Early systemic cellular immune response in children and young adults receiving decellularized fresh allografts for pulmonary valve replacement. Tissue Eng Part A 20(5\u20136):1003\u201311","journal-title":"Tissue Eng Part A"},{"issue":"2","key":"4312_CR25","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.athoracsur.2019.02.058","volume":"108","author":"S Sarikouch","year":"2019","unstructured":"Sarikouch S, Theodoridis K, Hilfiker A et al (2019) Early Insight Into In Vivo Recellularization of Cell-Free Allogenic Heart Valves. Ann Thorac Surg 108(2):581\u2013589","journal-title":"Ann Thorac Surg"},{"key":"4312_CR26","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.895943","volume":"9","author":"F Oripov","year":"2022","unstructured":"Oripov F, Ramm R, Falk C et al (2022) Serial assessment of early antibody binding to decellularized valved allografts. Front Cardiovasc Med 9:895943","journal-title":"Front Cardiovasc Med"},{"issue":"4","key":"4312_CR27","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1093\/ejcts\/ezaa393","volume":"59","author":"J Ebken","year":"2021","unstructured":"Ebken J, Mester N, Smart I et al (2021) Residual immune response towards decellularized homografts may be highly individual. Eur J Cardiothorac Surg 59(4):773\u2013782","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04312-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-026-04312-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04312-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:17:56Z","timestamp":1779689876000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-026-04312-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":27,"alternative-id":["4312"],"URL":"https:\/\/doi.org\/10.1007\/s00246-026-04312-1","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"10 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}