Pulmonary Valve Function Late After Ross Procedure in 443 Adult Patients
| Autor: | Peter D. Skillington, Tyson A. Fricke, William Y. Shi, Edward Buratto, Leeanne Grigg, Rochelle Wynne, Marco Larobina |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty Adolescent Heart Ventricles medicine.medical_treatment Magnetic Resonance Imaging Cine 030204 cardiovascular system & hematology Prosthesis Design Transplantation Autologous Young Adult 03 medical and health sciences 0302 clinical medicine Pulmonary Valve Replacement parasitic diseases medicine Humans Postoperative Period Aged Retrospective Studies Heart Valve Prosthesis Implantation Pulmonary Valve Lung business.industry Ross procedure Middle Aged medicine.disease Pulmonary Valve Insufficiency Surgery Pulmonary Valve Stenosis Transplantation medicine.anatomical_structure 030228 respiratory system Pulmonary valve Pulmonary valve stenosis Ventricular Function Right Female Cardiology and Cardiovascular Medicine business Echocardiography Stress Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 109:1127-1131 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.07.060 |
| Popis: | Background Limited data exist on long-term pulmonary valve function after the Ross procedure. This study sought to determine the long-term function of the pulmonary valve in 443 consecutive adult patients who underwent a Ross procedure. Methods All 443 patients who underwent a Ross procedure between November 1992 and March 2018 were reviewed retrospectively. All underwent pulmonary valve replacement using a cryopreserved pulmonary allograft. Freedom from the study’s outcomes were calculated using Kaplan Meier survival. Risk factors for valve failure were analyzed using Cox regression. Results Mean age at time of operation was 39 years (range: 15-66 years). There was 1 (0.2%, 1 of 443) operative mortality. Nine patients required reintervention on the pulmonary allograft at a mean 6.1 years (range: 1-12 years) after Ross procedure. Patients required pulmonary allograft reintervention for infective endocarditis (n = 4), severe pulmonary stenosis (n = 4), or severe pulmonary regurgitation (n = 1). Freedom from pulmonary allograft reintervention was 98.9% (95% confidence interval [CI] 97.1%-99.6%), 97.7% (95% CI 95.1%-98.9%), 96.6% (95% CI 93.3%-98.3%), and 96.6% (95% CI 93.3%-98.3%) at 5, 10, 15, and 20 years, respectively. Freedom from pulmonary allograft dysfunction (at least moderate pulmonary regurgitation and/or mean systolic gradient ≥ 25 mm Hg and/or reintervention) was 94.5% (95% CI 91.6%-96.4%), 88.1% (95% CI 83.6%-91.4%), 84.9% (95% CI 79.6%-88.9%), and 78.3% (95% CI 69.5%-84.9%) at 5, 10, 15, and 20 years, respectively. No risk factors were identified to influence pulmonary valve durability. Conclusions The pulmonary valve allograft gives excellent long-term function when used in adults undergoing the Ross procedure. Reintervention on the pulmonary valve is rare and significant pulmonary allograft dysfunction is uncommon. |
| Databáze: | OpenAIRE |
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