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Title: Pulmonary homograft stenosis in the Ross procedure: Incidence, clinical impact and predictors in long-term follow-up.
Authors: Pardo González, Laura
Ruiz Ortiz, Martin
Delgado, Mónica
Mesa, Dolores
Villalba, Rafael
Rodriguez, Sara
Hidalgo, Francisco J
Alados, Pedro
Casares, Jaime
Suarez de Lezo, Jose
Keywords: Aortic valve;Homograft;Homogreffe;Procédure de Ross;Ross procedure;Survie;Survival;Valve aortique
metadata.dc.subject.mesh: Adolescent
Age Factors
Aortic Valve
Aortic Valve Stenosis
Child, Preschool
Disease-Free Survival
Heart Valve Prosthesis Implantation
Kaplan-Meier Estimate
Longitudinal Studies
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Pulmonary Valve
Pulmonary Valve Stenosis
Risk Factors
Severity of Illness Index
Tertiary Care Centers
Time Factors
Treatment Outcome
Young Adult
Issue Date: 30-Dec-2016
Abstract: The Ross procedure is used in the treatment of selected patients with aortic valve disease. Pulmonary graft stenosis can appear in the long-term follow-up after the Ross intervention, but the factors involved and its clinical implications are not fully known. To describe the incidence, clinical impact and predictors of homograft stenosis and reintervention after the Ross procedure in a prospective series in a tertiary referral hospital. From 1997 to 2009, 107 patients underwent the Ross procedure (mean age: 30±11 years; 69% men; 21 aged36mmHg) and surgical or percutaneous homograft reintervention. After 15 years of follow-up (median: 11 years), echocardiographic and clinical data were available in 91 (85%) and 104 (98%) patients, respectively: 26/91 (29%) patients developed homograft stenosis; 10/104 (10%) patients underwent 13 homograft reintervention procedures (three patients underwent surgical replacement, three received a percutaneous pulmonary valve and one needed stent implantation). The other three patients underwent two consecutive procedures in follow-up; one died because of a procedure-related myocardial infarction. Rates of survival free from homograft stenosis and reintervention at 1, 5 and 10 years were 96%, 82% and 75% and 99%, 94% and 91%, respectively. Paediatric patients had worse survival free from homograft stenosis (hazard ratio [HR] 3.50, 95% confidence interval [CI]: 1.56-7.90; P=0.002), although there were no significant differences regarding reintervention (HR: 2.01, 95% CI: 0.52-7.78; P=0.31). Younger age of homograft donor was also a stenosis predictor (HR: 0.97, 95% CI: 0.94-0.99; P=0.046). The probabilities of homograft stenosis and reintervention 10 years after the Ross procedure were 29% and 10%, respectively; only one patient had a reintervention-related death. Younger donor and recipient age were associated with a higher rate of stenosis.
metadata.dc.identifier.doi: 10.1016/j.acvd.2016.09.008
Appears in Collections:Producción 2020

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