Abstract

Aim
Comparison of the long-term benefits of decellularised pulmonary homografts (DPH) and conventional bioprosthetic valves in pulmonary valve replacement (PVR) and right ventricular outflow tract (RVOT) on durability, structural valve deterioration (SVD), haemodynamic efficacy, and reintervention percentage.

Method
In line with PRISMA guidelines, this study identified articles in PubMed, MEDLINE, Embase, Cochrane CENTRAL, and Scopus using keywords for decellularised pulmonary homografts, pulmonary valve replacement, RVOT reconstruction, and bioprosthetic conduits. The search resulted in 1,751 papers. After 752 duplicates were removed, 999 papers remained. Titles and s were screened to identify those studies evaluating PVR or RVOT reconstruction with DPH versus bioprosthetic conduits with extractable outcome data (n = 45). Quantitative comparative studies reporting mortality, reintervention, SVD, haemodynamic, or infective endocarditis were included yielding (n = 14). A random-effects meta-analysis was conducted, and heterogeneity was validated by I² statistics.

Results
Notably, the DPH had greater freedom from reintervention, lower SVD, and favourable postoperative valve gradients than that of the bioprosthetic conduits across the included studies. Infective endocarditis was more prevalent in bovine jugular vein valves. There was no disparity observed for early and late mortality. Heterogeneity across different outcomes was moderate.

Conclusions
Decellularised pulmonary homografts are the best candidates due to greater durability, better structural integrity, and enhanced haemodynamic performance relative to traditional bioprosthetic valves for PVR and RVOT reconstruction. These results support DPH as a viable biological system to use, particularly in younger patients requiring prolonged valve life. Further prospective studies with long-term follow-up are warranted.