The freestanding root, inclusion, and subcoronary techniques in the Ross procedure provide comparable excellent hemodynamics, normal root size, and distensibility, except for the enlarged sinus diameter in the freestanding root. These results may have some impact on the operative procedure and follow-up investigations.
Background
Homograft valves have been shown to be immunogenic, but it is unknown whether this affects valve function. Therefore, we prospectively studied the degree of histoincompatibility (defined as the number of human leukocyte antigen [HLA] mismatches between valve donor and recipient) and the response of the recipient (measured by antibodies against HLA) in relation to echocardiographic parameters of homograft valve function after the Ross procedure.
Methods and Results
Twenty-six patients (mean age 41±14 years; 20 males, 6 females) and the cryopreserved pulmonary homograft valves that were implanted during a Ross procedure were typed for HLA-A, HLA-B, and HLA-DR. After a mean follow-up of 15±6 months, 14 (54%) of the patients were anti–HLA class I antibody positive. In all but 1 patient, these antibodies were shown to be donor specific. During follow-up, there was a significant increase of the maximal (+6.2±7.1 mm Hg) and mean (+3.2±4.3 mm Hg) transhomograft pressure gradients but not of homograft regurgitation. Neither the number of HLA mismatches nor antibody status was found to have significant impact on homograft valve function. In a multivariate analysis, smaller homograft size (
P
=0.001) and younger recipient age (
P
=0.044) were shown to be significantly associated with increased transhomograft pressure gradients.
Conclusions
Implantation of a cryopreserved pulmonary homograft during the Ross procedure can induce a specific humoral response. We observed a significant increase of the transhomograft pressure gradients within 15±6 months after surgery. For this period, we were unable to demonstrate a relationship between this increase and the degree of histoincompatibility.
Einleitung Im Gegensatz zur Mitralklappenchirurgie, bei der die Rekonstruktion der nativen Klappe einen unbestrittenen und festen Stellenwert besitzt, wird die Aortenklap− penrekonstruktion bislang nur verhält− nismäßig selten praktiziert. Die Gründe hierfür liegen in den historisch als schlecht überlieferten Ergebnissen der Aortenklappenrekonstruktion, dem Feh− len eines geeigneten intraoperativen Tests zur unmittelbaren Beurteilung des Re− konstruktionsergebnisses, der kommer− ziellen Verfügbarkeit von geeigneten Klappensubstituten und den guten Er− gebnissen damit. Dennoch ist in den letz− ten Jahren ein verstärktes Interesse an Aortenklappenrekonstruktionen zu ver− zeichnen. Der vorliegende Artikel zeigt die Gründe für dieses (wiedererwachte) Interesse auf, stellt die zur Verfügung ste− henden chirurgischen Techniken sowie deren Ergebnisse vor und bemüht sich, den Stellenwert der Aortenklappenre− konstruktion in der modernen herzchi− rurgischen Praxis aufzuzeigen. Die Pro− bleme, die sich bei Neugeborenen oder Kindern mit Aortenklappenvitien stellen, sind jedoch wesentlich komplexer und nicht Gegenstand dieses Artikels.
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