[Incidence and clinical impact of pulmonary homograft dysfunction after the Ross procedure].
OBJECTIVE
We analyzed the incidence, risk factors and clinical impact of pulmonary homograft dysfunction after the Ross procedure in our patients.


METHODS
All patients were evaluated at 3, 6 and 12 months, and annually thereafter. Patients with a transhomograft pressure gradient greater than 30 mmHg were referred for cardiac magnetic resonance imaging.


RESULTS
At the end of the study, 9 patients (11.8%) showed a transhomograft pressure gradient >30 mmHg after a mean period of 15.3 months post-surgery. Mean transhomograft pressure gradient was 19.8 (16.2%) (range, 2-100 mmHg). All patients were in functional class I, except 2 who were in New York Heart Association class II with severe stenosis. These 2 patients were treated percutaneously with stent placement and no reoperation. No association was found between clinical outcome and sex, age or homograft diameter. We found a trend toward greater perioperative use of plasma, platelets and red cells in the group of patients in comparison to controls, although the difference was significant only for postoperative use of plasma (1.7 [3] vs 5.5 [5.3] units; P<0.05). Cardiac magnetic resonance imaging showed stenosis predominantly in the body of the homograft, whereas the valvular component itself remained competent. Right ventricular hypertrophy was mild or very mild in 7 patients and moderate in 2.


CONCLUSIONS
The incidence of some degree of pulmonary homograft dysfunction after the Ross procedure was non-negligible, but its clinical impact seems to be slight. Patients with severe stenosis were treated successfully via a percutaneous approach. The use of blood products might be a risk factor for the development of this complication.
Aranda Granados
Pedro J
PJ
Servicio de Cirugía Cardiovascular. Hospital Universitario Reina Sofía. Córdoba. Spain.
Concha Ruiz
Manuel
M
Casares Mediavilla
Jaime
J
Merino Cejas
Carlos
C
Muñoz Carvajal
Ignacio
I
Alados Arboledas
Pedro
P
Mesa Rubio
Dolores
D
Ribes
Ramón
R
Villalba Montoro
Rafael
R
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization; D002648:Child; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation*; D011666:Pulmonary Valve Stenosis / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D014182:Transplantation, Autologous; D016896:Treatment Outcome