Abstract 2465: The Pulmonary Homograft in 1162 Ross Patients - Results from the Dutch-German Ross Registry
Background: The Ross operation presents with favourable postoperative hemodynamics and clinical results. Usage of a pulmonary homograft (HG) is associated with an elevated risk of valve substitute pathology. This study was conducted in order to evaluate the clinical development of the HG in a large international Ross operated cohort.
Methods and Results: 1162 pts were studied (882 m, 280 f, mean age 38.8.2 ± 16.3y) with a maximum follow-up of 17.5 years (mean 5.1 ± 3.7 y). For statistical analysis of serial echocardiographic measurements a hierarchical multilevel modeling was applied. At the time of last follow-up, 84% showed no, trivial or I° HG-regurgitation (HR), 5.6% revealed a higher grade HR (II° 5.3%; III° 0.2%; IV° 0.10%, 10% unknown), mean HR grade at baseline was 0.41 with an annual increase of 0.031 grade/year. Seven pts (0.6%) required a reoperation due to HR. Young age, early phase of surgical learning curve, short HG-length, z-values >1, no HG-adjustments and higher donor age are associated with higher HR grade. Development of pulmonary homograft stenosis (HS) is shown in table 1⇓. Reoperation for severe HS was necessary in 27 pts (2.3%). Mean HS at baseline was 4.48 mmHg with an annual increase of 0.133 mmHg/year. Young age at time of surgery, male gender and z-values < −1 are associated with higher HS grade. HG-endocarditis was detected in 17 pts (1.5%) with 5 reoperations. Freedom from homograft reoperation was 99.5% at 1y and 96.1% at 8y. 44 pts died during follow-up (cardiac 29, non-cardiac 15). 3 deaths were valve related (2 HG).
Conclusion: Clinical relevant HR is rare in the midterm in pts in the Dutch-German Ross Registry. HS of potential clinical impact occurs in a minority of pts. The HG gradient tends to increase within the first 2 years post-operatively. In order to improve HG outcome, risk associated predictors ought to be considered whenever possible. Although HG-endocarditis occurs infrequently, it should be allowed for in Ross pts with unknown fever.