Decellularized Pulmonary Xenograft Matrix PplusN versus Cryopreserved Homograft for RVOT Reconstruction during Ross Procedure in Adults

2021 ◽  
Author(s):  
Kiril Penov ◽  
Matz Andreas Haugen ◽  
Dejan Radakovic ◽  
Khaled Hamouda ◽  
Armin Gorski ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Statistical Tests ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Matrix Group ◽  
Age Difference ◽  
Ross Procedure ◽  
The Matrix ◽  
Pulmonary Valve Regurgitation

Abstract Background Decellularized pulmonary homografts are being increasingly adopted for right ventricular outflow tract reconstruction in adult patients undergoing the Ross procedure. Few reports presented Matrix PplusN xenograft (Matrix) in a negative light. The objective of this study was to compare our midterm outcomes of Matrix xenograft versus standard cryopreserved pulmonary homograft (CPHG). Methods Eighteen patients received Matrix xenograft between January 2012 and June 2016, whereas 66 patients received CPHG. Using nonparametric statistical tests and survival analysis, we compared midterm echocardiographic and clinical outcomes between the groups. Results Except for significant age difference (the Matrix group was significantly older with 57 ± 8 years than the CPHG group, 48 ± 9 years, p = 0.02), the groups were similar in all other baseline characteristics. There were no significant differences in cardiopulmonary bypass times (208.3 ± 32.1 vs. 202.8 ± 34.8) or in cross-clamp times (174 ± 33.9 vs. 184.4 ± 31.1) for Matrix and CPHG, respectively. The Matrix group had significantly inferior freedom from reintervention than the CPHG group with 77.8 versus 98.5% (p = 0.02). Freedom from pulmonary valve regurgitation ≥ 2 was not significantly different between the groups with 82.4 versus 90.5% for Matrix versus CPHG, respectively. After median follow-up of 4.9 years, Matrix xenograft developed significantly higher peak pressure gradients compared with CPHG (20.4 ± 15.5 vs. 12.2 ± 9.0 mm Hg; p = 0.04). Conclusion After 5 years of clinical and echocardiographic follow-up, the decellularized Matrix xenograft had inferior freedom from reintervention compared with the standard CPHG. Closer follow-up is necessary to avoid progression of valve failure into right ventricular deterioration.

scholarly journals Different conduits for the right ventricular outflow tract reconstruction in adults during the Ross procedure

2015 ◽  
Vol 17 (2) ◽  
pp. 23 ◽  
Author(s):  
A. M. Karaskov ◽  
I. I. Demin ◽  
R. M. Sharifulin ◽  
S. I. Zheleznev ◽  
A. V. Bogachev-prokofev ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Multivariable Analysis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ross Procedure ◽  
Acceptable Alternative ◽  
The Right ◽  
Pulmonary Homograft

We compared different conduits for the right ventricular outflow tract reconstruction (RVOT) in adults during the Ross procedure. Between 1998 and 2012, 586 consecutive adult patients underwent the Ross procedures. Mean age was 45,514,2 years. The RVOT was reconstructed with a diepoxy-treated xenografts in 372 and with glutaraldehyde-treated in 88 patients. A pulmonary homograft was used in 125 patients. Hospital mortality was 4,9%. Mean follow up was 43,216,9 months. At discharge systolic gradient was 8,1 3,7 mm.Hg for the pulmonary homograft, 11,44,7 mm.Hg for the diepoxytreated and 14,96,1 mm.Hg for the glutaraldehyde-treated xenopericardial conduits. Twenty eight patients underwent reoperation. The 3-year actuarial freedom from conduit explantation for pulmonary homograft was 100%, for diepoxy- and glutaraldehyde-treated xenopericardial conduits 99,20,7% and 84,74,7% respectively. Multivariable analysis identified the type of xenograft and age as independent factors for xenograft dysfunction. Results from this study show that the pulmonary homograft is the most preferred conduit for the RVOT reconstruction during the Ross procedure. The diepoxy-treated xenopericardial conduits are acceptable alternative to the homograft in patients older 45 years.

scholarly journals RIGHT VENTRICULAR OUTFLOW TRACT RECONSTRUCTION DURING THE ROSS PROCEDURE: COMPARISON OF PULMONARY ALLOGRAFTS AND PERICARDIAL XENOGRAFTS

2018 ◽  
Vol 7 (2) ◽  
pp. 71-78
Author(s):  
R. M. Sharifulin ◽  
A. V. Bogachev-Prokophiev ◽  
I. I. Demin ◽  
A. B. Open ◽  
M. A. Ovcharov ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Group Versus ◽  
Right Ventricular Outflow Tract ◽  
Study Groups ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Pressure Gradients ◽  
Ross Procedure ◽  
The Right

Aim The aim of this study was to compare the results of right ventricular outflow tract reconstruction during the Ross procedure with pulmonary allografts versus diepoxide-treated pericardial xenografts. Methods Between 1998 and 2015, 793 adult patients underwent the Ross procedure. The right ventricular outflow tract reconstruction was performed with pulmonary allografts in 185 patients, diepoxide-treated pericardial xenografts in 402 patients. Two groups of patients (122 patients in each group) were allocated using «propensity score matching»: the allograft group (pulmonary allograft) and the xenograft group (xenograft). Surgical results in two groups were assessed. Results The overall early mortality rate in both groups was 2.5%. The mean follow-up was 5,1±2,6 years in the allograft group and 5,2±2,8 years in xenograft group (p = 0,692). The 5-year survival rate did not differ between the study groups (93,7±2,6% in the allograft group versus 94,02±2,4% in the xenograft group, p = 0.748). The peak pressure gradients across the right ventricular outflow tract in early and mid-term follow-up were significantly higher in the xenograft group. Two patients in the xenograft group underwent redo surgeries due to the graft failure. There were no reoperations in the allograft group (p = 0,176). The freedom from right ventricular outflow tract reoperations was 96,3±2,7% for the xenograft group. Conclusion The diepoxide-treated pericardial xenografts demonstrates acceptable haemodynamic results at the mid-term follow-up and could be considered as an alternative to allografts for right ventricular outflow tract reconstruction during the Ross procedure in adults. Further study focused on the assessment of the longterm results are required.

scholarly journals Right ventricular outflow tract stenting during neonatal and infancy periods: A multi-center, retrospective study

2020 ◽  
Vol 28 (3) ◽  
pp. 442-449
Author(s):  
İbrahim Cansaran İbrahim Cansaran Tanıdır
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Double Outlet Right Ventricle ◽  
Outflow Tract ◽  
Complex Congenital Heart Disease ◽  
Total Correction ◽  
Study Results ◽  
Correction Surgery

Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein’s anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity.

Contegra versus pulmonary homograft for right ventricular outflow tract reconstruction in newborns

2019 ◽  
Vol 29 (4) ◽  
pp. 505-510 ◽  
Author(s):  
Alessandro Falchetti ◽  
Hélène Demanet ◽  
Hugues Dessy ◽  
Christian Melot ◽  
Charalampos Pierrakos ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Heart Surgery ◽  
Multivariable Analysis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Congenital Heart Surgery ◽  
Outflow Tract ◽  
Conflicting Evidence ◽  
Pulmonary Homograft

AbstractObjectives:Pulmonary homografts are standard alternatives to right ventricular outflow tract reconstruction in congenital heart surgery. Unfortunately, shortage and conduit failure by early calcifications and shrinking are observed for small-sized homografts in younger patients. In neonates, Contegra® 12 mm (Medtronic Inc., Minneapolis, Minnesota, United States of America) could be a valuable alternative, but conflicting evidence exists. There is no published study considering only newborns with heterogeneous pathologies. We retrospectively compared the outcomes of these two conduits in this challenging population.Methods:Patients who underwent a right ventricular outflow tract reconstruction between January 1992 and December 2014 at the Hôpital Universitaire des Enfants Reine Fabiola were included. We retrospectively collected and analysed demographic, echocardiographic, surgical, and follow-up data.Results:Of the 53 newborns who benefited from a right ventricular outflow tract reconstruction during the considered period, 30 received a Contegra 12 mm (mean age 15 ± 8 days), and 23 a small (9–14 mm) pulmonary homograft (mean age 10 ± 7 days). Overall mortality was 16.6% with Contegra versus 17.4% in the pulmonary homograft group (p = 0.98 log-rank). Operative morbidity and early re-operation for conduit failure were not significantly different between the two groups. Mean follow-up in this study is 121 ± 74 months. Survival free from re-operation was not different between the two groups (p = 0.15). Multivariable analysis showed that weight and significant early gradient were factors associated with anticipated conduit failure.Conclusions:Contegra 12 mm is a valid alternative to small pulmonary homografts in a newborn patient population. Trial registration: NCT03348397.

Reconstruction of Right Ventricular Outflow Tract with Stentless Xenografts in Ross Procedure

2002 ◽  
Vol 26 (12) ◽  
pp. 1055-1059 ◽  
Author(s):  
Takuro Tsukube ◽  
Yujiro Kawanishi ◽  
Hirohisa Murakami ◽  
Yutaka Hino ◽  
Ritsu Matsukawa ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ross Procedure

scholarly journals Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short- to mid-term results

2020 ◽  
Author(s):  
Ahmadali Amirghofran ◽  
Fatemeh Edraki ◽  
Mohammadreza Edraki ◽  
Gholamhossein Ajami ◽  
Hamid Amoozgar ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Right Atrial ◽  
The Mean ◽  
Mid Term Results ◽  
Tetralogy Of Fallot Repair

Abstract OBJECTIVES The prevention of pulmonary insufficiency (PI) is a crucial part of the tetralogy of Fallot repair. Many techniques have been introduced to construct valves from different materials for the right ventricular outflow tract, including the most commonly constructed monocusp valves. We are introducing a new bicuspid valve made intraoperatively using the autologous right atrial appendage (RAA) to prevent PI in these patients. METHODS The RAA valve was constructed and used in 21 patients with tetralogy of Fallot. The effective preservation of the native valve was impossible in all patients because of either a severe valve deformity or a small annulus. The RAA valve was created after ventricular septal defect closure and right ventricular outflow tract myectomy and was covered with a bovine transannular pericardial patch. The perioperative data were evaluated, and the echocardiography results were assessed immediately after operations and in follow-up with a median of 10.5 months. The data were retrospectively compared with 10 other patients with similar demographic data but with only transannular patches. RESULTS The mean age of the patients was 13.3 months. No mortality or related morbidity occurred after repair using the RAA valve. The PI severity early after the operation was trivial or no PI in 18 patients, and mild PI was observed in 3 patients, which progressed to moderate PI in one of them in the mean 12-month follow-up period. Fifteen patients had mild or no pulmonary stenosis, while moderate pulmonary stenosis was observed in 6 others. Compared with the other 10 patients with only transannular patches, the RAA valve patients had prolonged operative and clamping times, but no difference in postoperative course and shorter hospital stays. The degree of PI was, of course, significantly less in the RAA valve patients, but pulmonary stenosis was the same. CONCLUSIONS The RAA valve construction is a safe and effective technique to prevent PI after the tetralogy of Fallot repair, at least in terms of short- and mid-term results. A longer follow-up period is needed to confirm if this new valve can eliminate or significantly delay the need for pulmonary valve replacement in these patients.

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