Mid-Term Pulmonary Homograft Function for Right Ventricular Outflow Tract Reconstruction in the Ross Procedure.

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.

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Results of large pulmonary homograft implantation for right ventricular outflow tract reconstruction

Journal of Cardiac Surgery ◽

10.1111/jocs.15184 ◽

2020 ◽

Author(s):

Simon Dang Van ◽

Carine Pavy ◽

Guillaume Guimbretière ◽

Julie Boulanger ◽

Pierre Maminirina ◽

...

Keyword(s):

Right Ventricular ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Pulmonary Homograft

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

Cardiology in the Young ◽

10.1017/s1047951119000143 ◽

2019 ◽

Vol 29 (4) ◽

pp. 505-510 ◽

Cited By ~ 2

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.

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Aortic Root and Right Ventricular Outflow Tract Reconstruction Using Composite Biological Valved Conduits After Failed Ross Procedure

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2011.01.035 ◽

2011 ◽

Vol 91 (6) ◽

pp. e87-e89

Author(s):

Mark J. Russo ◽

Rachel Easterwood ◽

Mathew R. Williams ◽

Isaac George ◽

Allan S. Stewart

Keyword(s):

Right Ventricular ◽

Aortic Root ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Ross Procedure

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

Artificial Organs ◽

10.1046/j.1525-1594.2002.07005_3.x ◽

2002 ◽

Vol 26 (12) ◽

pp. 1055-1059 ◽

Cited By ~ 3

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

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Results of large pulmonary homograft implantation for right ventricular outflow tract reconstruction

10.22541/au.159242020.01930647 ◽

2020 ◽

Author(s):

Simon DANG VAN ◽

Carine Pavy ◽

Guillaume Guimbreti re ◽

Julie Boulanger ◽

Pierre Maminirina ◽

...

Keyword(s):

Right Ventricular ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Pulmonary Homograft

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Early failure of decellularized xenogenous pulmonary valve conduit (Matrix-P-Plus) for reconstruction of the right ventricular outflow tract in the ross procedure

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1367197 ◽

2014 ◽

Vol 62 (S 01) ◽

Cited By ~ 2

Author(s):

I. Breitenbach ◽

A. El-Essawi ◽

D. Pahari ◽

T. Kappenberg ◽

W. Harringer ◽

...

Keyword(s):

Right Ventricular ◽

Pulmonary Valve ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Ross Procedure ◽

Early Failure ◽

Valve Conduit ◽

The Right

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Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa244 ◽

2020 ◽

Vol 59 (1) ◽

pp. 162-169

Author(s):

Ravil Sharifulin ◽

Alexander Bogachev-Prokophiev ◽

Igor Demin ◽

Alexander Afanasyev ◽

Mikhail Ovcharov ◽

...

Keyword(s):

Propensity Score ◽

Right Ventricular ◽

Propensity Score Matching ◽

Survival Rates ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Long Term Results ◽

Ross Procedure ◽

Graft Dysfunction

Abstract OBJECTIVES Pulmonary allografts (AG) are the gold standard for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure. However, there is limited availability of AG in some countries, and the use of alternative grafts for RVOT reconstruction remains controversial. This study aimed to compare the rates of freedom from RVOT graft dysfunction for AG and diepoxide-treated pericardial xenografts (DPXG). METHODS Between 1998 and 2015, 793 adult patients underwent the Ross procedure in our centre. Using propensity score matching, the clinical outcomes and echocardiographic results of AG and DPXG were compared. RESULTS Propensity score matching resulted in 2 groups (AG and DPXG) of 122 patients each. No difference was found in early mortality (2.5%) in both groups. The freedom from RVOT graft dysfunction curves were comparable between the AG and DPXG groups (P = 0.186) and the 8-year rates of freedom from graft dysfunction were 91.8% and 82.2%, respectively. The survival rates at 8 years were 90.5% and 90.1%, and the rates of freedom from RVOT reintervention at 8 years were 100% and 96.8% for the AG and DPXG groups, respectively. At discharge and follow-up, transprosthetic gradients were significantly higher in the DPXG group. The rate of the RVOT gradient progression was also higher in the DPXG group than in the AG group (1.80 ± 0.06 vs 1.39 ± 0.04 mmHg/year, P < 0.001). CONCLUSIONS There was no difference in freedom from RVOT graft dysfunction by 8 years when using AG and DPXG in adult Ross patients, nor in survival and freedom from RVOT conduit reintervention. Long-term results need further evaluation.

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