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.
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.