The Occurrence
of Postoperative Pulmonary Homograft Stenosis in Adult Patients Undergoing
the Ross Procedure
William H. Ryan, Morley A. Herbert,
Todd M. Dewey, Shivum Agarwal, Anne L. Ryan, Syma L. Prince, Michael
J. Mack
Presbyterian Hospital of Dallas, Cardiopulmonary
Research Science and Technology Institute, Dallas, Medical City
Dallas Hospital, Dallas, Texas, USA |
Background and aim of the study: The Ross procedure employs
an autologous pulmonary valve to replace the aortic valve, but requires
pulmonary homograft replacement. Concerns regarding long-term homograft
function may limit the adoption of this technique. Herein, the incidence
of, and factors leading to, stenosis of the homograft were examined.
Methods: Data were collected from 131 patients (32 females, 99 males) who
underwent a Ross procedure between July 1994 and December 2003. Complete
follow up data were collected from 113 of 125 (90.4%) living patients.
Donor valve information, including storage time, was supplied by the graft
manufacturers. Data were analyzed using chi-square tests, t-test and logistic
regression.
Results: The mean patient follow up was 703 ± 574 days (median 599
days; range: 2 to 2,408 days). Echocardiographic stenosis had occurred
in 14 patients (12.4%). Four patients (3.2%) required homograft replacement,
and two required balloon valvuloplasty. There was no significant difference
in graft vendor, recipient, donor age or blood type match |
between stenotic and non-stenotic recipients. Donor valve
size was appropriate for the recipients, and greater than predicted by
recipient body surface area (BSA). Donor valves that developed stenosis
had a shorter storage time after processing (160 ± 100 versus
249 ± 223 days; p = 0.03). Male donor valves became stenotic in
9.9% (7/71) of male recipients, but in none of 20 females. Female donor
valves became stenotic in 27.3% (3/11) of male recipients, and in 28.6%
(2/7) females. Logistic regression showed donor gender to be a significant
predictor for stenosis (p = 0.007; odds ratio 14.1 for female/male donors;
95% CI 2.1-96.4).
Conclusion: Donor valves which developed stenosis had a shorter mean cryopreservation
time than those that did not develop stenosis. In addition, female donor
homografts appeared to develop stenosis at a greater rate, independent
of patient age, graft size to BSA match, and blood type.
The Journal of Heart Valve Disease 2006;15:108-114
|