Ann Thorac Surg. 2023 Jul 8:S0003-4975(23)00693-8. doi: 10.1016/j.athoracsur.2023.06.024. Online ahead of print.
ABSTRACT
BACKGROUND: We aim to longitudinally compare expanded-polytetrafluoroethylene (ePTFE) valved vs pulmonary homograft (PH) conduits after right ventricular outflow tract reconstruction in the Ross procedure.
METHODS: We identified patients undergoing a Ross procedure from June 2004 to December 2021. Echocardiographic data, catheter-based interventions or conduit replacement as well as time to first reintervention or replacement were comparatively assessed between handmade ePTFE-valved and PH conduits.
RESULTS: A total of 90 patients were identified. The median age, and weight were 13.8 years (IQR 8.08-17.80) and 48.3 kg (IQR 26.8-68.7). There were 66% (n=60) ePTFE-valved conduits and 33% (n=30) PH. The median size was 22 mm (IQR 18-24) for ePTFE-valved conduits and 25 mm (IQR 23-26) for PH conduits (p<0.001). Conduit type has no differential effect in the gradient evolution or the odds of presenting with severe regurgitation in the last follow-up echocardiogram. Out of the 26 first reinterventions, 81% were catheter-based interventions, without statistically significant differences between the groups (69% PH vs. 83% ePTFE). The overall surgical conduit replacement was 15% (n=14), being higher in the homograft group (30% vs 8%; p=0.008). However, conduit type was not associated with increased hazard for reintervention or reoperation after adjusting for covariates.
CONCLUSIONS: RVOT reconstruction using handmade ePTFE-valvedconduits after a Ross procedure provides encouraging midterm results, without a differential effect in hemodynamic performance or valve function compared to PH. These results reassure the utilization of handmade valved conduits in pediatric population and young adults. Longer follow-up of tricuspid conduits will complement valve competency assessment.
PMID:37429515 | DOI:10.1016/j.athoracsur.2023.06.024
