title: Comparison between homografts and Freestyle® bioprosthesis for right ventricular outflow tract replacement in Ross procedures.
abstract: OBJECTIVE
  Although data from large series indicate the satisfactory performance of bioprosthetic valves in the right ventricular outflow tract (RVOT), replacement of the pulmonary valve in adult patients undergoing the Ross procedure is usually performed with pulmonary allografts. We evaluated the outcomes of homografts vs. bioprosthetic RVOT replacement after the Ross procedure in adults.
  
  
  METHODS
  Between 1996 and 2011, a total of 186 adult patients (141 male; mean age 44 ± 10 years) underwent aortic root replacement with a pulmonary autograft. The RVOT was replaced with a homograft in 113 patients and with stentless bioprostheses (Medtronic Freestyle(®)) in 73. Patients were followed for a mean of 6 years (range 1-15 years; 1106 patient years).
  
  
  RESULTS
  Twelve patients required reintervention owing to dysfunction of the RVOT replacement, which was caused by endocarditis (n = 4), degeneration (n = 2) or stricture at the proximal suture line (n = 6). For homografts, the incidence of reintervention was 1 in 150 patient years, compared with 1 in 36 patient years for stentless bioprostheses (P = 0.007). The median gradient was 15 mmHg for the homograft group and 24 mmHg for bioprosthesis (P < 0.0001). The incidence of gradients >40 mmHg was 10-fold higher in the bioprosthetic group.
  
  
  CONCLUSIONS
  Patients with bioprostheses in the RVOT position after the Ross procedure showed a significantly higher risk of reintervention or pulmonary valve dysfunction. The main problem, early development of a stricture at the proximal suture line, has to be solved to achieve satisfactory bioprosthetic function in the RVOT.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang-Goethe University Hospital, Frankfurt am Main, Germany. miskovic@gmx.net
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Miskovic
authors.forename: Nadejda
authors.initials: N
authors.lastname: Monsefi
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.forename: Feyzan
authors.initials: F
authors.lastname: Özaslan
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Karimian
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000601:surgery* / Q000637:transplantation; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome