The long-term durability of valved homograft conduit in right ventricular outflow tract reconstruction after Ross surgery and non-Ross surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DUN Yaojun , ZHAO Dong , HUA Zhongdong , YAN Jun , LI Shoujun ,  YANG Keming

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

YANG Keming, Email: 13801217526@163.com

Keywords：

Valved homograft conduit; right ventricular outflow tract; Ross surgery; non-Ross surgery; long-term durability

DOI：

10.7507/1007-4848.202108019

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Objective To compare the long-term durability of valved homograft conduit (VHC) in patients with Ross and non-Ross right ventricular outflow tract (RVOT) reconstruction. Methods Patients who underwent RVOT reconstruction using VHC in Fuwai Hospital from January 2008 to October 2020 were retrospectively included. Patients who received Ross RVOT reconstruction were allocated to a Ross group and patients who received non-Ross RVOT reconstruction were allocated to a non-Ross group. The survival and reintervention-free rates of the two groups were evaluated with the Kaplan-Meier survival curve and log-rank test. The propensity score matching analysis was performed on the patients who completed ultrasound follow-up in the two groups, and the VHC dysfunction-free rate was compared between the two groups. Results A total of 243 patients were enrolled, including 142 males and 101 females, with a median age of 6 years (4 months to 56 years). There were 77 patients in the ROSS group and 166 patients (168 operations) in the non-ROSS group. The cardiopulmonary bypass time in the Ross group was shorter than that in the non-Ross group (175.4±45.6 min vs. 200.1±83.5 min, P=0.003). Five patients in the non-Ross group died early after the operation. The follow-up was available in 231 patients (93.1%), with the average follow-up time of 61.7±44.4 months. During the follow-up, 5 patients in the non-Ross group died. The 12-year survival rate was 100.0% in the Ross group and 93.2% in the non-Ross group (log-rank, P=0.026). In addition, 1 patient in the Ross group and 7 patients in the non-Ross group received VHC reintervention. There was no significant difference in the reintervention-free rate between the two groups (log-rank, P=0.096). Among the 73 patients in the Ross group and 147 patients in non-Ross group who were followed up by ultrasound after discharge, 45 patients (20.5%) developed VHC dysfunction. Before matching, the long-term durability of VHC in the Ross group was better than that in non-Ross group (10-year VHC dysfunction-free rate: 66.6% vs. 37.1%, log-rank, P=0.025). After the propensity score matching, 64 patients included in each group, and there was no statistical difference in the long-term durability of VHC between the two groups (10-year VHC dysfunction-free rate: 76.3% vs. 43.0%, log-rank, P=0.065). In the subgroup analysis, the 10-year VHC dysfunction-free rate in the Ross group was higher than that in the non-Ross group (71.0% vs. 20.0%, log-rank, P=0.032) among patients aged<6 years at surgery. However, there was no significant difference in the 10-year VHC dysfunction-free rate between the two groups (53.7% vs. 56.7%, log-rank, P=0.218) among patients aged ≥6 years at surgery. Conclusion After the propensity score matching analysis, the long-term durability of VHC has no significant difference between the Ross group and non-Ross group. The long-term durability of VHC after Ross surgery is superior to that of non-Ross surgery in patients aged<6 years at surgery.

Citation： DUN Yaojun, ZHAO Dong, HUA Zhongdong, YAN Jun, LI Shoujun, YANG Keming. The long-term durability of valved homograft conduit in right ventricular outflow tract reconstruction after Ross surgery and non-Ross surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 884-889. doi: 10.7507/1007-4848.202108019 Copy

1.	Ross DN, Somerville J. Correction of pulmonary atresia with a homograft aortic valve. Lancet, 1966, 2(7479): 1446-1447.
2.	O'Brien MF, Stafford G, Gardner M, et al. The viable cryopreserved allograft aortic valve. J Card Surg, 1987, 2(1 Suppl): 153-167.
3.	Fernández-Carbonell A, Rodríguez-Guerrero E, Merino-Cejas C, et al. Predictive factors for pulmonary homograft dysfunction after ross surgery: A 20-year follow-up. Ann Thorac Surg, 2021, 111(4): 1338-1344.
4.	Selamet Tierney ES, Gersony WM, Altmann K, et al. Pulmonary position cryopreserved homografts: Durability in pediatric Ross and non-Ross patients. J Thorac Cardiovasc Surg, 2005, 130(2): 282-286.
5.	Niwaya K, Knott-Craig CJ, Lane MM, et al. Cryopreserved homograft valves in the pulmonary position: Risk analysis for intermediate-term failure. J Thorac Cardiovasc Surg, 1999, 117(1): 141-146.
6.	Boethig D, Goerler H, Westhoff-Bleck M, et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg, 2007, 32(1): 133-142.
7.	Ruzmetov M, Geiss DM, Shah JJ, et al. Does the homograft for RVOT reconstruction in ross: Patients fare better than for non-ross patients? A single-center experience. J Heart Valve Dis, 2015, 24(4): 478-483.
8.	Sharifulin R, Bogachev-Prokophiev A, Demin I, et al. Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg, 2021, 59(1): 162-169.
9.	Tweddell JS, Pelech AN, Frommelt PC, et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation, 2000, 102(19 Suppl 3): Ⅲ130-Ⅲ135.
10.	张晶, 刘迎龙, 谢宁, 等. 同种带瓣管道应用的远期效果. 中华胸心血管外科杂志, 2001, 17(2): 68-70.
11.	Forbess JM, Shah AS, St Louis JD, et al. Cryopreserved homografts in the pulmonary position: Determinants of durability. Ann Thorac Surg, 2001, 71(1): 54-59.
12.	Herrmann JL, Brown JW. Seven decades of valved right ventricular outflow tract reconstruction: The most common heart procedure in children. J Thorac Cardiovasc Surg, 2020, 160(5): 1284-1288.
13.	Bando K, Danielson GK, Schaff HV, et al. Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg, 1995, 109(3): 509-517.
14.	Kalfa D, Macé L, Metras D, et al. How to choose the best available homograft to reconstruct the right ventricular outflow tract. J Thorac Cardiovasc Surg, 2011, 142(4): 950-953.
15.	Kalfa DM, Loundou A, Nouaille de Gorce Y, et al. Pulmonary position cryopreserved homograft in non-Ross patients: How to improve the results? Eur J Cardiothorac Surg, 2012, 42(6): 981-987.
16.	Lenzi AW, Olandoski M, Ferreira WS, et al. Dysfunction of the pulmonary homograft used in the reconstruction of the right ventricle exit tract. Arq Bras Cardiol, 2011, 96(1): 2-7.
17.	Livi U, Abdulla AK, Parker R, et al. Viability and morphology of aortic and pulmonary homografts. A comparative study. J Thorac Cardiovasc Surg, 1987, 93(5): 755-760.
18.	蔡小满, 刘锦纷, 张海波. 同种异体带瓣管道重建右室流出道的耐久性随访研究. 中华胸心血管外科杂志, 2005, 21(6): 341-343.

1. Ross DN, Somerville J. Correction of pulmonary atresia with a homograft aortic valve. Lancet, 1966, 2(7479): 1446-1447.
2. O'Brien MF, Stafford G, Gardner M, et al. The viable cryopreserved allograft aortic valve. J Card Surg, 1987, 2(1 Suppl): 153-167.
3. Fernández-Carbonell A, Rodríguez-Guerrero E, Merino-Cejas C, et al. Predictive factors for pulmonary homograft dysfunction after ross surgery: A 20-year follow-up. Ann Thorac Surg, 2021, 111(4): 1338-1344.
4. Selamet Tierney ES, Gersony WM, Altmann K, et al. Pulmonary position cryopreserved homografts: Durability in pediatric Ross and non-Ross patients. J Thorac Cardiovasc Surg, 2005, 130(2): 282-286.
5. Niwaya K, Knott-Craig CJ, Lane MM, et al. Cryopreserved homograft valves in the pulmonary position: Risk analysis for intermediate-term failure. J Thorac Cardiovasc Surg, 1999, 117(1): 141-146.
6. Boethig D, Goerler H, Westhoff-Bleck M, et al. Evaluation of 188 consecutive homografts implanted in pulmonary position after 20 years. Eur J Cardiothorac Surg, 2007, 32(1): 133-142.
7. Ruzmetov M, Geiss DM, Shah JJ, et al. Does the homograft for RVOT reconstruction in ross: Patients fare better than for non-ross patients? A single-center experience. J Heart Valve Dis, 2015, 24(4): 478-483.
8. Sharifulin R, Bogachev-Prokophiev A, Demin I, et al. Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg, 2021, 59(1): 162-169.
9. Tweddell JS, Pelech AN, Frommelt PC, et al. Factors affecting longevity of homograft valves used in right ventricular outflow tract reconstruction for congenital heart disease. Circulation, 2000, 102(19 Suppl 3): Ⅲ130-Ⅲ135.
10. 张晶, 刘迎龙, 谢宁, 等. 同种带瓣管道应用的远期效果. 中华胸心血管外科杂志, 2001, 17(2): 68-70.
11. Forbess JM, Shah AS, St Louis JD, et al. Cryopreserved homografts in the pulmonary position: Determinants of durability. Ann Thorac Surg, 2001, 71(1): 54-59.
12. Herrmann JL, Brown JW. Seven decades of valved right ventricular outflow tract reconstruction: The most common heart procedure in children. J Thorac Cardiovasc Surg, 2020, 160(5): 1284-1288.
13. Bando K, Danielson GK, Schaff HV, et al. Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg, 1995, 109(3): 509-517.
14. Kalfa D, Macé L, Metras D, et al. How to choose the best available homograft to reconstruct the right ventricular outflow tract. J Thorac Cardiovasc Surg, 2011, 142(4): 950-953.
15. Kalfa DM, Loundou A, Nouaille de Gorce Y, et al. Pulmonary position cryopreserved homograft in non-Ross patients: How to improve the results? Eur J Cardiothorac Surg, 2012, 42(6): 981-987.
16. Lenzi AW, Olandoski M, Ferreira WS, et al. Dysfunction of the pulmonary homograft used in the reconstruction of the right ventricle exit tract. Arq Bras Cardiol, 2011, 96(1): 2-7.
17. Livi U, Abdulla AK, Parker R, et al. Viability and morphology of aortic and pulmonary homografts. A comparative study. J Thorac Cardiovasc Surg, 1987, 93(5): 755-760.
18. 蔡小满, 刘锦纷, 张海波. 同种异体带瓣管道重建右室流出道的耐久性随访研究. 中华胸心血管外科杂志, 2005, 21(6): 341-343.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The long-term durability of valved homograft conduit in right ventricular outflow tract reconstruction after Ross surgery and non-Ross surgery

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