Abstract 15970: Importance of Vascular Factors on Long-term Integrity of Valvular Grafts Following a Ross Procedure in a Young Adult Population
Introduction: Valves degeneration after Ross procedure is not yet predictable in young adult. We thus aimed to identify determinants of echocardiographic degeneration of autograft and homograft.
Methods: 310 patients underwent a Ross procedure. Patients with endocarditis (active or not; n=28), previous aortic valve replacement (n=11) and insufficient echocardiographic follow-up (n=5) were excluded. Valve degeneration was defined as an increase of mean transvalvular gradient>10mmHg or an increase>1/4 of insufficiency grade when compared to post-operative values.
Results: Mean age at time of surgery was 41±11years and median follow-up time was 15 years (range=1–25 years). 83(31%) autografts and 108(41%) homografts presented degeneration. The independent determinants of homograft degeneration were the presence of increased mean pulmonary artery pressure during follow-up (Hazard ratio [HR]=1.25/5mmHg increase; p=0.002) and greater homograft sizes (HR=1.15/1mm increase; p=0.02). On aortic side, ascending aorta replacement prosthesis (HR=11.10; p<0.0001), increased systolic blood pressure during follow-up (HR=1.15/5mmHg increase; p=0.03) and greater arterial compliance (HR=1.24/0.1ml·mmHg-1·m-2 increase; p=0.0003) were independently linked to autograft degeneration. Furthermore, the presence of mild insufficiency at discharge (n=6 on autografts and n=12 on homografts), although absent at peroperative transoesophageal echocardiography, was significantly associated with faster degeneration (HR=36.90; p<0.0001 and HR=29.26; p<0.0001 for homograft and autograft respectively).
Conclusions: In this series of Ross procedure patients, both systemic and pulmonary hypertensions were independently associated with faster degeneration of autografts and homografts, respectively. These results suggest that tight blood pressure control should be introduced throughout the life in order to possibly prevent future reoperations. The association between ascending aorta prosthesis and autograft degeneration could be linked to an active process or a passive marker of aorta collagen impairment. Further studies are required to differentiate these hypotheses.
Author Disclosures: L. Simard: None. J. Perron: None. M. Shen: None. L. Tastet: None. S. Mohammadi: None. M. Clisson: None. É. Martin: None. A. Poulin: None. M. Clavel: None.
- © 2016 by American Heart Association, Inc.