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.