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Pulmonary homograft muscle reduction to reduce the risk of homograft stenosis in the Ross procedure
- Source :
- The Journal of Thoracic and Cardiovascular Surgery. 133(1):190-195
- Publication Year :
- 2007
- Publisher :
- Elsevier BV, 2007.
-
Abstract
- ObjectiveThe Ross procedure has gained increasing interest as an attractive alternative for aortic valve replacement. Despite its advantages, there is a certain risk of structural valve deterioration, especially of the pulmonary homograft as a result of shrinkage and subsequent stenosis predominantly at the muscular annulus. Theoretically, reduction of homograft muscle tissue could reduce this risk.MethodsFrom February 1996 through December 2002, a total of 238 patients (mean age 44 ± 13.2 years) underwent the Ross procedure with the subcoronary technique with follow-up investigations before discharge and after 12 and 24 months. To estimate the importance of homograft muscle reduction within our institution-specific risk factor scale for change of transhomograft pressure gradient with time, we performed a generalized estimating equation approach, which identified homograft muscle reduction, higher body surface area in male patients, younger patient age, smaller homograft diameter, blood transfusions, and follow-up time as independent risk factors demonstrating a high β value (−2.8638) for muscle reduction. To find out whether muscle reduction influences transhomograft pressure gradient, we compared patients with (group A, n = 39) and without (group B, n = 199) muscle reduction. The other mentioned independent risk factors were not different between groups, except for blood transfusions (group A greater than B, P < .01), indicating a negative bias for group A.ResultsThe maximum pressure gradient across the homograft was lower in patients with muscle reduction before discharge (4.5 ± 2.8 mm Hg group A vs 6.2 ± 3.8 mm Hg group B, P = .004) and after 1 (9.3 ± 5.8 vs 13.1 ± 8.4 mm Hg, P = .028) and 2 years (10.8 ± 7.6 vs 13.7 ± 7.5 mm Hg, P = .013). No significant differences were found concerning homograft insufficiency.ConclusionsWe provide some evidence that transhomograft pressure gradient can be reduced significantly within the first 2 years after operation by homograft muscle reduction. Longer term follow-up is necessary to evaluate this promising operative technique further.
- Subjects :
- Muscle tissue
Aortic valve
Thorax
Adult
Male
Reoperation
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Constriction, Pathologic
Postoperative Complications
Aortic valve replacement
Risk Factors
medicine
Humans
Transplantation, Homologous
Risk factor
Cardiac Surgical Procedures
Aged
Body surface area
Pulmonary Valve
business.industry
Ross procedure
Muscle, Smooth
Middle Aged
medicine.disease
Surgery
Stenosis
medicine.anatomical_structure
Echocardiography
Aortic Valve
Female
business
Cardiology and Cardiovascular Medicine
Subjects
Details
- ISSN :
- 00225223
- Volume :
- 133
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- The Journal of Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....7b604dc030f945984bf11070115da01b
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2006.08.055