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DOI: 10.1055/s-0037-1598968
Early Failure of Tissue-Engineered Pulmonary Valve Conduits Used for Right Ventricular Outflow Tract Reconstruction in Adult ROSS Patients. A Word of Caution
Publication History
Publication Date:
03 February 2017 (online)
Objective: Reconstruction of right ventricular outflow tract (RVOT) in ROSS procedures are commonly performed with cryopreserved homografts. Due to lack of homografts xenogenous decellularized pulmonary valve conduits could be a valuable alternative.
Methods: From 01/2012 to 06/2016, n = 86 Ross procedure were performed, in n = 56 patients the RVOT was reconstructed with a cryopreserved homograft (group1; age 49 (41–55), and in n = 18 patients (group2, age 58 (56–61)) a xenogenous decellularized pulmonary valve conduit (Matrix P plus) was used.
Results: Mean follow was 25.7 ± 16.7 and 28.4 ± 14.6 months, respectively. Beside age (p < 0.001) patients characteristics were comparable. Postoperative right ventricular function was comparable between groups, however, in group 2 slight but significant higher RVOT gradients were detected (6 mm Hg [range: 4–8 mm Hg] vs. 10 mm Hg (range: 5.3–13.5 mm Hg), p = 0.021); furthermore, higher incidence of pulmonary valve insufficiency (PI ≥ II°) was present (0 vs. 12%, p = 0.041). Reoperation for RVOT failure was necessary in n = 3 group 2 patients and in none group 1 patient (16.7 vs. 0%; p = 0.009). Indication for reoperation were increasing pulmonary valve insufficiency (n = 1), dilation of RVOT conduit (n = 1) or endocarditis (n = 1) .
Conclusion: Due to frequent early conduit failures the Matrix P plus de-cellularized tissue-engineered pulmonary valve cannot be regarded as an alternative for right ventricular outflow tract reconstruction in adult ROSS patients.