Pulmonary homograft dysfunction after Ross procedure in adults: a single center experience

Abstract

The Ross procedure was first proposed by Donald Ross in 1967. Numerous studies show excellent long-term outcomes of the Ross operation. One of its disadvantages is the intervention on two valves due to pulmonary homograft dysfunction.Aim.  To study long-term outcomes of pulmonary homograft use after Ross operation (cumulative incidence of pulmonary homograft dysfunction, freedom from reoperation on pulmonary homograft, long-term survival, predictors of pulmonary homograft dysfunction) using data from one Russian center.Material  and  methods. A retrospective study included patients aged 18 years and older with aortic valve disease who underwent Ross procedure from April 2009 to December 2020 by a single surgeon. The age of the patients was 35 (26-44) years (men, 159 (75%)). Infective endocarditis as a cause of aortic valve pathology was diagnosed in 55 (26%) patients. Bicuspid aortic valve was diagnosed in 131 (62%) patients. The median follow-up period was 79 (26,5102,7) months.Results. Combined interventions were performed in 40 cases (18,9%). The modified Ross procedure was used in 54 (25,5%) cases (intra-aortic — 29, using Dacron tube graft — 25). Inhospital mortality was 0,5%. The 5- and 10-year allcause survival rates were 98,5% and 95,4%, while the 10-year cumulative pulmonary valve reoperation rate and pulmonary homograft dysfunction was 4,6% and 35,2%, respectively. The only factor affecting pulmonary homograft dysfunction was patient age ≤30 years (odds ratio =0,2 with 95% confidence interval: 0,06-0,7; p=0,02).Conclusion. Fresh pulmonary homografts have a low incidence of dysfunction and reintervention after Ross procedure. Young age is the only independent risk factor for pulmonary homograft dysfunction.