title: [Incidence and clinical impact of pulmonary homograft dysfunction after the Ross procedure].
abstract: 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.
authors.affiliation: Servicio de Cirugía Cardiovascular. Hospital Universitario Reina Sofía. Córdoba. Spain.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Aranda Granados
authors.forename: Manuel
authors.initials: M
authors.lastname: Concha Ruiz
authors.forename: Jaime
authors.initials: J
authors.lastname: Casares Mediavilla
authors.forename: Carlos
authors.initials: C
authors.lastname: Merino Cejas
authors.forename: Ignacio
authors.initials: I
authors.lastname: Muñoz Carvajal
authors.forename: Pedro
authors.initials: P
authors.lastname: Alados Arboledas
authors.forename: Dolores
authors.initials: D
authors.lastname: Mesa Rubio
authors.forename: Ramón
authors.initials: R
authors.lastname: Ribes
authors.forename: Rafael
authors.initials: R
authors.lastname: Villalba Montoro
mesh_terms: 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