title: Stentless porcine bioprosthesis in pulmonary position after ross procedure: midterm results.
abstract: BACKGROUND
  Stentless porcine roots (SPV) have been proposed for right ventricular outflow tract reconstruction in the Ross procedure due to the relative availability of pulmonary homografts in large diameters. We report here our experience with SPV used in the Ross procedure.
  
  
  METHODS
  Between March 1992 and February 2011, 360 patients had a Ross procedure; 61 patients received a SPV in pulmonary position and they represent the study population. Mean age was 38 ± 7.6 years. Indication for surgery was an infective endocarditis in 15 cases, there were 3 redo operations. Median SPV diameter was 29 mm (range, 25 to 29 mm). Pulmonary stenosis was defined as a peak transvalvular gradient of more than 50 mm Hg.
  
  
  RESULTS
  Perioperative mortality was 4.9% (3 patients) and late mortality was 3.3% (2 patients). Median follow-up was 4 years (range, 7 days to 14.9 years). There was no reoperation on the right ventricle outflow tract, and freedom from pulmonary stenosis was 100% at 5 years. Mean transpulmonary gradients were 7.1 ± 3.1 mm Hg and 13.5 ± 6.8 mm Hg postoperatively and at 5 years, respectively. Mean transpulmonary gradient increased faster over time when the SPV diameter was less than 29 mm (p = 0.03).
  
  
  CONCLUSIONS
  The SPV could represent an alternative to cryopreserved pulmonary homografts during the Ross procedure in adult patients. Hemodynamic results were improved by using large diameter SPV, but longer follow-up is mandatory to confirm those results.
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France. Electronic address: juthier.francis@gmail.com.
authors: Francis
authors: F
authors: Juthier
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
authors: André
authors: A
authors: Vincentelli
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
authors: Ilir
authors: I
authors: Hysi
authors: Department of Biostatistics, Université Lille Nord de France, Lille, France.
authors: Claire
authors: C
authors: Pinçon
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
authors: Natacha
authors: N
authors: Rousse
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
authors: Carlo
authors: C
authors: Banfi
authors: Department of Cardiovascular Surgery, Centre Hospitalier Regional et Universitaire de Lille, Lille, France.
authors: Alain
authors: A
authors: Prat
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult