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DOI: 10.1055/s-0029-1247050
Early degeneration of a Shelhigh No-React prosthesis in the pulmonary position after a Ross procedure in adults
Background: The reconstruction of the right ventricular outflow tract with a homograft is a standard procedure in Ross operations. Because of donor shortage, stentless xenograft valves including the Shelhigh No-React prosthesis were used as a substitute. As the Shelhigh No-React prosthesis has been reported to suffer early degeneration in aortic position we reviewed our Ross patients with regard to their xenograft function.
Methods: In our institution, 171 Ross procedures were performed from 1999 to 2007. Sixteen Shelhigh No-React prosthesis were implanted in pulmonary position. During short-term follow-up, we found 3 patients with symptomatic pulmonary valve stenosis.
Results: 27mm and 29mm Shelhigh No-React prosthesis were implanted in 3 the patients, 27, 58 and 59 years of age. 23 to 43 month after the Ross procedure, the patients became symptomatic. In all patients the aortic autograft remained normal. Echocardiography and MRI demonstrated a systolic pressure gradient over the pulmonary valve of 25–70mmHg with an effective orifice area of 0.4 to 0.8 qcm along with right ventricular dilatation, as well as a periprosthetic liquid formation. One patient was successfully re-operated with a homograft. The second one is scheduled; the third refused surgery. Histology of the explanted prothesis revealed lymphoid and foam cell infiltrates indicating an immunologic reaction. There were no signs of infection.
Conclusion: Early failure of the Shelhigh prothesis is not only detected in aortic position (high pressure) but also in pulmonary position (low pressure). Immunologic reaction might be the reason for degeneration and early xenograft failure.