Effective transcatheter valve implantation after pulmonary homograft failure: a new perspective on the Ross operation.
OBJECTIVE
The Ross procedure offers good autograft function and low reoperation rates for the neoaortic valve; however, the rate of conduit dysfunction in the right ventricular outflow tract remains a concern. This study assessed percutaneous pulmonary valve implantation in this setting.


METHODS
We retrospectively analyzed outcomes of 12 patients (mean age 28 +/- 5 years) referred for percutaneous pulmonary valve implantation to treat right ventricle-pulmonary artery conduit failure 11.1 +/- 3.3 years after Ross procedure.


RESULTS
Percutaneous pulmonary valve implantation was feasible in all 12 patients, with no procedural complications (procedure time 99 +/- 16 minutes, fluoroscopy time 21 +/- 6 minutes). Right ventricular outflow tract gradient during catheterization and pulmonary regurgitant fraction on magnetic resonance imaging fell after valve implantation (gradient 34 +/- 6 to 14 +/- 3 mm Hg, P < .01, regurgitant fraction 20% +/- 6% to 2% +/- 1%, P < .05). After restoration of right ventricular outflow tract function, indexed right ventricular end-diastolic volume decreased (91 +/- 13 to 78 +/- 12 mL x beat(-1) x m(-2), P < .01) and maximal cardiopulmonary exercise performance improved (peak oxygen consumption 25.4 +/- 2.3 to 30.8 +/- 3.0 mL x kg(-1) x min(-1), P < .01). During follow-up (18.8 +/- 4.6 months), there was 1 device explantation (restenosis). The probabilities of freedom from right ventricular outflow tract reoperation were 100% at 1 year and 90% at 3 years.


CONCLUSIONS
Percutaneous pulmonary valve implantation provides an effective transcatheter treatment strategy to prolong the lifespan of right ventricle-pulmonary artery conduits after the Ross procedure, reducing the reoperation burden on patients with aortic valve disease.
Nordmeyer
Johannes
J
UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
Lurz
Philipp
P
Tsang
Victor T
VT
Coats
Louise
L
Walker
Fiona
F
Taylor
Andrew M
AM
Khambadkone
Sachin
S
de Leval
Marc R
MR
Bonhoeffer
Philipp
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D014184:Transplantation, Homologous; D055815:Young Adult