Predictive Factors for Pulmonary Homograft Dysfunction After Ross Surgery: A 20-Year Follow-up
| Autor: | Marta Fernández-Carbonell, Rafael Villalba-Montoro, José Rafael Caro-Barrera, Pedro Alados-Arboledas, Enrique Rodríguez-Guerrero, Pedro López-Cillero, Carlos Merino-Cejas, Azahara Fernández-Carbonell, Maria T. Conejero-Jurado, María del Carmen Romero-Morales, Jaime Casares-Mediavilla |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Percutaneous Adolescent medicine.medical_treatment Heart Valve Diseases Hemodynamics 030204 cardiovascular system & hematology Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors Humans Medicine Cardiac Surgical Procedures Risk factor Child Aged Retrospective Studies Pulmonary Valve business.industry Incidence (epidemiology) Ross procedure Hazard ratio Middle Aged Allografts medicine.disease Confidence interval Surgery body regions Stenosis surgical procedures operative 030228 respiratory system Echocardiography Child Preschool Female Primary Graft Dysfunction Cardiology and Cardiovascular Medicine business Follow-Up Studies Forecasting |
| Zdroj: | The Annals of Thoracic Surgery. 111:1338-1344 |
| ISSN: | 0003-4975 |
| Popis: | Background We studied the determinants of hemodynamics and analyzed the incidence, risk factors, and clinical impact of pulmonary homograft dysfunction following Ross surgery, after a 20-year follow-up at our referral center. Methods From 1997 to 2017, a total of 142 patients underwent surgery using the Ross procedure. The development of moderate-severe stenosis (peak transhomograft pressure gradient 36 mm Hg or greater) and surgical or percutaneous Ross homograft reinterventions were evaluated by echocardiography in the immediate postoperative period and at annual intervals. Results After 20 years of follow-up, 31% of patients had moderate-severe homograft stenosis, and 9.1% had had to undergo one or two reinterventions, of which, six were valve replacements and seven were percutaneous interventions. At 1, 5, and 20 years, 89.4%, 74.6%, and 69% of these patients, respectively, were free from moderate-severe stenosis; and 99.3%, 95.7%, and 90.9%, respectively, had freedom from homograft reintervention. The pediatric group had a higher risk factor for homograft stenosis (hazard ratio 3.70; 95% confidence interval, 1.56 to 7.20, P = .002), whereas donor age behaved as a protective factor (hazard ratio 0.98; 95% confidence interval, 0.95 to 0.99; P = .044). Pulmonary homograft stenosis tended to appear in the first year (10.6%) or at 5 years (25.4%). Conclusions Pulmonary homografts implanted in the Ross procedure offer satisfactory long-term results, but the level of homograft dysfunction is not negligible. Young recipient and donor age were associated with a higher rate of homograft stenosis during follow-up. Moreover, homograft dysfunction usually occurred during the first few years of follow-up, and may have been related to immune responses. |
| Databáze: | OpenAIRE |
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