{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:29Z","timestamp":1792785869048,"version":"4.5.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"CORTISS Hannover, Herz-und Gewebeforschungs-GmbH and Kleine Herzen Westerwald e. V"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Fresh, non-cryopreserved and non-seeded, decellularized pulmonary homografts (DPHs) were translated in 2005 into clinical practice. The aim of this current study is to summarize our 20-year clinical experience with DPH for pulmonary valve replacement (PVR) in congenital heart disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective follow-up of all DPH implanted within 2 institutions. Indication for PVR according to current clinical guidelines was the key inclusion criterion without age limits; patients with active endocarditis were not included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From January 2005 to August 2025, 310 patients (188 male) received DPH for PVR. Median patient age at implantation was 14.8 years, (interquartile range [IQR] 12.7-16.6 years, min. 0.1 years, max.72.8 years), and the median DPH diameter was 22 mm (IQR 19-23 mm, min. 12 mm, max 34 mm). Median follow-up was 8.3 years (IQR 4.5-12.1, max 20.5 years). Seven out of 310 patients died, a freedom from death according Kaplan-Meier of 96.9% (confidence interval [CI] 93.1%-98.6%) at 20 years. Freedom from DPH explantation was 85.2% (CI 75.1%-91.4%), and freedom from endocarditis was 91.0% (CI 77.1%-96.6%) at 20 years. Valve function showed a steady decline over the study period. At 15 years, freedom from stenosis, as defined as a maximum gradient of \u2265 50 mmHg, was 68.3% (CI 52.4%-79.8%) and 0 at 20 years. Freedom from \u2265 moderate pulmonary regurgitation was 65.1% (CI 48.1%-77.7%) at 15 years and 0 at 20 years. The number of patients at risk beyond 15 years was limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Decellularized pulmonary homografts show good long-term results for PVR with freedom from explantation that appears favourable compared with published long-term series of cryopreserved homografts. However, our data also indicate a decline in valve function over 2 decades. We hypothesize that residual immunogenicity is the underlying cause, suggesting that there is potential for further refinement of decellularization methods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezag087","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T12:25:13Z","timestamp":1770035113000},"source":"Crossref","is-referenced-by-count":4,"title":["20-Year Experience With Decellularized Pulmonary Homografts for Pulmonary Valve Replacement"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7277-7597","authenticated-orcid":false,"given":"Samir","family":"Sarikouch","sequence":"first","affiliation":[{"name":"Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , 30625 Hannover,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Boethig","sequence":"additional","affiliation":[{"name":"Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , 30625 Hannover,","place":["Germany"]},{"name":"Department for Paediatric Cardiology and Paediatric Intensive Care, Hannover Medical School , 30625 Hannover,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Avsar","sequence":"additional","affiliation":[{"name":"Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School , 30625 Hannover,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anatol","family":"Ciubotaru","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Center, State Medical and Pharmaceutical University , MD-2004 Chi\u0219in\u0103u,","place":["Moldova"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Cheptanaru","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Center, State Medical and Pharmaceutical University , MD-2004 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