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(Circulation. 2001;104:I-25.)
© 2001 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Does Histocompatibility Affect Homograft Valve Function After the Ross Procedure?

J.F. Matthias Bechtel, MD; Claus Bartels, MD; Claudia Schmidtke, MD; Wim Skibba; Michael Müller-Steinhardt, MD; Harald Klüter, MD; Hans-Hinrich Sievers, MD, FETCS

Clinic for Cardiac Surgery (J.F.M.B., C.B., C.S., W.S., H.-H.S.) and the Institute for Immunology and Transfusion Medicine (W.S., M.M.-S.), Medical University of Luebeck, Luebeck, Germany, and the Institute of Transfusion Medicine and Clinical Immunology (H.K.), Faculty of Clinical Medicine at Mannheim, University of Heidelberg, Heidelberg, Germany.

Correspondence to Prof Dr H.H. Sievers, Klinik für Herzchirurgie, Universitaetsklinikum Luebeck, Ratzeburger Alle 160, 23538 Luebeck, Germany. E-mail sievers{at}medinf.mu-luebeck.de

Background— Homograft valves have been shown to be immunogenic, but it is unknown whether this affects valve function. Therefore, we prospectively studied the degree of histoincompatibility (defined as the number of human leukocyte antigen [HLA] mismatches between valve donor and recipient) and the response of the recipient (measured by antibodies against HLA) in relation to echocardiographic parameters of homograft valve function after the Ross procedure.

Methods and Results— Twenty-six patients (mean age 41±14 years; 20 males, 6 females) and the cryopreserved pulmonary homograft valves that were implanted during a Ross procedure were typed for HLA-A, HLA-B, and HLA-DR. After a mean follow-up of 15±6 months, 14 (54%) of the patients were anti–HLA class I antibody positive. In all but 1 patient, these antibodies were shown to be donor specific. During follow-up, there was a significant increase of the maximal (+6.2±7.1 mm Hg) and mean (+3.2±4.3 mm Hg) transhomograft pressure gradients but not of homograft regurgitation. Neither the number of HLA mismatches nor antibody status was found to have significant impact on homograft valve function. In a multivariate analysis, smaller homograft size (P=0.001) and younger recipient age (P=0.044) were shown to be significantly associated with increased transhomograft pressure gradients.

Conclusions— Implantation of a cryopreserved pulmonary homograft during the Ross procedure can induce a specific humoral response. We observed a significant increase of the transhomograft pressure gradients within 15±6 months after surgery. For this period, we were unable to demonstrate a relationship between this increase and the degree of histoincompatibility.

Key Words: valves • surgery • transplantation • immunology