Durability of right ventricular conduits in the Ross procedure.

IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Karen B Abeln, Lennart Froede, Christian Giebels, Hans-Joachim Schäfers
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引用次数: 0

Abstract

Background: Right ventricular (RV) conduit availability and degeneration are potential limitations of the Ross procedure. Pulmonary homografts are the gold standard, but their limited availability drives the need for alternatives. The aim of this study was to compare results of different RV conduits.

Methods: Between 1995 and 2023, 315 consecutive patients (73% males; mean age, 37 ± 12 years) underwent a Ross procedure using a homograft (n = 211), bovine jugular vein (BJV) (n = 34), or xenograft (n = 70) as the RV conduit. The mean follow-up was 5.7 ± 6.7 years and was 96% complete (1631 patient-years).

Results: Twelve patients (homograft, n = 8; BJV. n = 3; xenograft, n = 1) required RV conduit reintervention, including 4 patients within 4 years (all with homografts). Indications for reintervention were degeneration in 8 patients and active endocarditis in 4 patients. Reinterventions included RV conduit replacement (homograft, n = 3; xenograft, n = 1; BJV, n = 2) and transcatheter valve implantation (homograft n = 5; BJV, n = 1). At 15 years, freedom from RV conduit reintervention was 88%, and freedom from reoperation was 93%. Freedom from reintervention at 15 years was similar in the homograft (89%), BJV (89%), and xenograft (100%) groups (P = .812). Progression of mean RV conduit gradient was lowest for the BJV group (1.45 mm Hg/year) and similar in the homograft (2.6 mm Hg/year) and xenograft (2.9 mm Hg/year) groups. Age at <18 years at surgery (hazard ratio [HR], 1.9; P < .001) was a predictive risk factor for reintervention. There was no difference among the RV conduit groups (HR, 1.198; P = .606).

Conclusions: The incidence of reintervention after 15 years is similar in recipients of homografts, xenografts, and BJV grafts. Interestingly, homografts may fail in the first few years, possibly related to inflammatory phenomena. Thus, the use of xenografts may be an option if homografts are not available.

罗斯手术中右心室导管的耐久性。
目的:右心室(RV)导管的可用性和退化是罗斯手术的潜在限制因素。肺动脉同种移植是黄金标准,但其可用性有限,因此需要替代方案。本研究旨在比较不同 RV 导管的效果:1995年至2023年间,315名连续患者(平均年龄:37±12岁,73%为男性)接受了Ross手术,使用同种移植物(n=211)、牛颈静脉('BJV')(n=34)或异种移植物(n=70)作为RV导管。平均随访时间为(5.7±6.7)年,随访完成率为 96%(1631 患者年):结果:12名患者(同种移植8/211,BJV 3/34,异种移植1/70)需要进行RV导管再介入,其中4名患者(同种移植)在4年内进行了再介入。重新介入的指征是变性(8 例)和活动性心内膜炎(4 例)。再介入包括 RV 导管置换(6 人,同种移植 3 人,异种移植 1 人,BJV 2 人)和经导管瓣膜植入(6 人,同种移植 5 人,BJV 1 人)。15年后,RV导管再介入的自由度为88%;再手术的自由度为93%。同种移植物(89%)、BJV(89%)和异种移植物(100%)的15年免再介入率相似(P=0.812)。BJV的平均RV导管梯度进展最小(1.45mmHg/年),同种移植(2.6mmHg/年)和异种移植(2.9mmHg/年)的平均RV导管梯度进展相似。手术年龄(结论:同种移植物、异种移植物和 BJV 15 年后再次介入的发生率相似。有趣的是,同种移植可能会在最初几年失败,这可能与炎症现象有关。因此,如果没有同种移植物,可以选择使用异种移植物。
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来源期刊
CiteScore
11.20
自引率
10.00%
发文量
1079
审稿时长
68 days
期刊介绍: The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.
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