title: Exploring the role of cyclosporine in reducing homograft degeneration post-Ross.
abstract: The Ross procedure is safe and effective for children with aortic valve disease. Pulmonary homograft degeneration, proposed to be immune-mediated, is a major cause of reoperation. Cyclosporine increased homograft valve survival in animals, but has not been studied in humans. To investigate the efficacy of low-dose cyclosporine in preventing homograft degeneration and complications, a retrospective historical-controlled study was performed on data of all children who underwent Ross procedure and received cyclosporine. The primary endpoint was homograft function at the last follow-up; secondary endpoints were readmission, reoperation, death, and safety. Seventeen patients were matched with 16 controls. At the end of the follow-up period (cyclosporine, 6.7 years; controls, 8 years), homograft stenosis and/or regurgitation were present in half of all patients. Three (18%) patients in the cyclosporine group and 5 (29%) in the control group were readmitted. Surgical intervention due to homograft failure was needed in 1 (6%) cyclosporine patient and 3 (19%) of the controls. Although cyclosporine failed to show a significant difference in signs of homograft degeneration, it might decrease the need for reoperation following the Ross procedure. Larger prospective well-designed studies are required to confirm these findings.
authors.affiliation: King Faisal Specialist Hospital, Research Center, Riyadh, Saudi Arabia. ajazairi@kfshrc.edu.sa
authors.forename: Abdulrazaq
authors.initials: A
authors.lastname: Al-Jazairi
authors.forename: Delal
authors.initials: D
authors.lastname: Alkortas
authors.forename: Zead
authors.initials: Z
authors.lastname: Bulbul
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Al-Zubairy
authors.forename: Maie
authors.initials: M
authors.lastname: Al-Shahid
authors.forename: Zohair
authors.initials: Z
authors.lastname: Al-Halees
mesh_terms: D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D016572:Cyclosporine / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000187:drug effects* / Q000637:transplantation*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012529:Saudi Arabia; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine