Stentless xenografts as an alternative to pulmonary homografts in the Ross operation†
| Autor: | Gebrine El Khoury, Ramadan Jashari, Julie Melchior, Philippe Noirhomme, Jean Rubay, Laurent de Kerchove, David Glineur, Bernhard Gerber, Emmanuel Coche, Jawad Hechadi |
|---|---|
| Přispěvatelé: | UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/IMAG - Pôle d'imagerie médicale, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de pathologie cardiovasculaire, UCL - (SLuc) Service de radiologie |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Heart Defects Congenital Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty Swine Heart Ventricles medicine.medical_treatment Heart Valve Diseases Hemodynamics Cohort Studies Postoperative Complications Bicuspid Aortic Valve Disease Internal medicine Pulmonary Valve Replacement medicine Humans Animals Ventricular outflow tract Four-Dimensional Computed Tomography Heart Valve Prosthesis Implantation Pulmonary Valve Lung business.industry Ross procedure General Medicine Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Aortic Valve Heart Valve Prosthesis Pulmonary valve Cardiology Heterografts Stents Female Cardiology and Cardiovascular Medicine business Calcification |
| Zdroj: | European Journal of Cardio-Thoracic Surgery, Vol. 44, no. 1, p. e32-e39 (2013) |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezt147 |
| Popis: | OBJECTIVES: Because of the limited availability of pulmonary homografts (PH), porcine stentless xenografts (SX) have been proposed as an alternative for pulmonary valve replacement in the Ross operation. However, it is unknown whether they have similar good long-term durability. Therefore, we compared mid- to long-term outcomes between those two right ventricular outflow tract (RVOT) substitutes. METHODS: In 288 adults (>18 years) undergoing a Ross operation between 1991 and 2012, Freestyle(®) SX was used in 18 patients and a cryopreserved PH was used in 270 for RVOT reconstruction. Only patients with follow-up >2 years were included. According to the operative period, gender and age, 37 patients with PH could be matched with 17 SX patients. Clinical and echocardiographic follow-up were obtained. In a subset of patients (SX, n = 11 and PH, n = 25), a cardiac computed tomographic (CT) scan was performed to analyse graft calcification. RESULTS: The mean follow-up period was 8.2 ± 4.0 (range 2-14.6 years). During this period, 3 patients died from cancer, 2 in the SX group and 1 in the PH group (P = 0.15). No patient needed RVOT reoperation. At follow-up, RVOT peak gradient was 21 ± 5.9 mmHg in the SX and 16.3 ± 8.7 in the PH groups (P = 0.07). Peak gradient >40 mmHg was observed in only 1 patient in the PH group. Mean RVOT regurgitation was 0.1 ± 0.4 in the SX group and 0.8 ± 0.6 in the PH group (P = 0.008). CT scan analyses showed progressive calcification mainly of the graft wall, while the valve remained relatively free of calcium. Patients with the SX presented significantly higher calcium scores than those with PH (P = 0.01). CONCLUSIONS: In adult patients having the Ross operation, calcic degeneration is observed in both the PH and the SX used as pulmonary substitutes. Calcification progresses more rapidly in the SX compared with the PH. In both grafts, calcifications affect mainly the wall, while the valve remains relatively free of calcium. As a consequence, both grafts show good and similar haemodynamic outcomes at mid- to long-term follow-up. The Freestyle(®) SX can be considered as an acceptable alternative for RVOT reconstruction when PH is not available. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|