Durability of Right Ventricular Conduits in the Ross Procedure.

Objectives: 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 (mean age:37±12years, 73% male) underwent a Ross procedure using a homograft (n=211), bovine jugular vein ('BJV') (n=34) or xenograft (n=70) as RV conduit. Mean follow-up was 5.7±6.7years and was 96% complete (1631 patient-years).

Results: Twelve patients (homograft 8/211, BJV 3/34, xenograft 1/70) required RV conduit reintervention, four patients (homograft) within 4 years. Indications for reintervention were degeneration (n=8) and active endocarditis (n=4). Reinterventions included RV conduit replacement (n=6, homograft n=3, xenograft n=1, BJV n=2) and transcatheter valve implantation (n=6, homograft n=5, BJV n=1). At 15years, freedom from RV conduit reintervention was 88%; freedom from reoperation was 93%. Freedom from reintervention at 15years was similar between homografts (89%), BJV (89%), and xenografts (100%)(p=0.812). Progression of mean RV conduit gradient was lowest for the BJV (1.45mmHg/year) and similar between the homograft (2.6mmHg/year) and xenograft (2.9mmHg/year). Age at surgery (<18years; p<0.001; HR 1.9) was a predictive risk factor for reintervention. There was no difference between RV conduits (p=0.606; HR 1.198).

Conclusions: The incidence of reintervention after 15years is similar between homografts, xenograft, and BJV. 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.