title: Pulmonary homograft stenosis in the Ross procedure: Incidence, clinical impact and predictors in long-term follow-up.
abstract: BACKGROUND
  The Ross procedure is used in the treatment of selected patients with aortic valve disease. Pulmonary graft stenosis can appear in the long-term follow-up after the Ross intervention, but the factors involved and its clinical implications are not fully known.
  
  
  OBJECTIVE
  To describe the incidence, clinical impact and predictors of homograft stenosis and reintervention after the Ross procedure in a prospective series in a tertiary referral hospital.
  
  
  METHODS
  From 1997 to 2009, 107 patients underwent the Ross procedure (mean age: 30±11 years; 69% men; 21 aged<18 years), and were followed for echocardiographic homograft stenosis (peak gradient>36mmHg) and surgical or percutaneous homograft reintervention.
  
  
  RESULTS
  After 15 years of follow-up (median: 11 years), echocardiographic and clinical data were available in 91 (85%) and 104 (98%) patients, respectively: 26/91 (29%) patients developed homograft stenosis; 10/104 (10%) patients underwent 13 homograft reintervention procedures (three patients underwent surgical replacement, three received a percutaneous pulmonary valve and one needed stent implantation). The other three patients underwent two consecutive procedures in follow-up; one died because of a procedure-related myocardial infarction. Rates of survival free from homograft stenosis and reintervention at 1, 5 and 10 years were 96%, 82% and 75% and 99%, 94% and 91%, respectively. Paediatric patients had worse survival free from homograft stenosis (hazard ratio [HR] 3.50, 95% confidence interval [CI]: 1.56-7.90; P=0.002), although there were no significant differences regarding reintervention (HR: 2.01, 95% CI: 0.52-7.78; P=0.31). Younger age of homograft donor was also a stenosis predictor (HR: 0.97, 95% CI: 0.94-0.99; P=0.046).
  
  
  CONCLUSIONS
  The probabilities of homograft stenosis and reintervention 10 years after the Ross procedure were 29% and 10%, respectively; only one patient had a reintervention-related death. Younger donor and recipient age were associated with a higher rate of stenosis.
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain. Electronic address: laurapardogonzalez@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Pardo González
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: Martin
authors.initials: M
authors.lastname: Ruiz Ortiz
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Mesa
authors.affiliation: Regional Blood Transfusion Centre and Tissue Bank, Córdoba, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Villalba
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Rodriguez
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Hidalgo
authors.affiliation: Department of Cardiovascular Surgery, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alados
authors.affiliation: Department of Cardiovascular Surgery, Reina Sofía University Hospital, Córdoba, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Casares
authors.affiliation: Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Suarez de Lezo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000637:transplantation*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic valve; Homograft; Homogreffe; Procédure de Ross; Ross procedure; Survie; Survival; Valve aortique