Reconstruction of Right Ventricular Outflow Tract with Stentless Xenografts in Ross Procedure

Abstract

To investigate whether the use of a stentless porcine aortic xenograft can be an alternative for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure, 9 patients underwent the Ross procedure and RVOT reconstruction with a stentless xenograft since January 2000. After the aortic valve was replaced with a pulmonary autograft, a stentless xenograft with a xeno- pericardial roll was implanted in the RVOT. One patient required subsequent aortic valve replacement because of severe regurgitation of the pulmonary autograft. All patients recovered well from the operation. The right ventricle-pulmonary arterial pressure gradient was 18 +/- 7 mm Hg at discharge and was not significantly increased during the 2-year follow-up period. Although 1 patient died of ventricular arrhythmia 5 months after, his cardiac function was normal, and transpulmonary valve pressure was 19 mm Hg in the follow-up. The other 7 patients are currently in New York Heart Association functional Class I. Although long-term follow-up is required to explain the durability, the stentless xenograft with a pericardial roll is considered to be an alternative for reconstruction of the RVOT within 2 years after the Ross procedure.

Expanded polytetrafluoroethylene-valved conduit with bulging sinuses for right ventricular outflow tract reconstruction in adults

“…12 Although excellent results using stentless valves for RVOT reconstruction were reported, there have been some reports about increasing PGs in the pulmonary position after RVOT reconstruction. 4,8,13 In our study, ePTFE-valved conduits for RVOT reconstruction did not increase the PG in the pulmonary position. Because the possibility of calcifi cation is reduced when using ePTFE materials, we can expect good long-term results with ePTFE valved conduits.…”

Right ventricular outflow tract reconstruction with Medtronic Freestyle valve in the Ross procedure: A systematic review with meta‐analysis

“…It appears that valve gradients increase during follow‐up. All six studies addressed this issue, five found an increase in valve gradients from discharge to end of follow‐up and one 12 found no significant difference. The difference in means between valve gradient (in mm Hg) at discharge and follow‐up in each study is reported in Figure 2A.…”

“…Of note, this study investigated a pediatric population; an early active inflammatory reaction resulting in extrinsic compression and shrinkage can, therefore, not be ruled out. No increase in valve gradients were seen in the cohort by Tsukube et al 12 Only three studies directly compared the Freestyle SX. Miskovic et al 10 and Weimar et al 13 highlighted the issue of higher rate of reintervention and pulmonary valve dysfunction when using Freestyle SX in the pulmonic position, suggesting that the higher peak gradients may have clinical impact.…”

“…A total of 1,715 citations were initially identified and, after removal of duplicates, 343 articles were screened. Of these, 18 studies were potentially relevant and retrieved as full-text articles, and six publications [8][9][10][11][12][13] fulfilled our eligibility criteria ( Figure 1).…”

A Novel Designed Valved Conduit for RVOT Reconstruction in Grown-up Congenital Heart Patients: a Glimpse Down the Road

“…This resulted in good hemodynamic results at midterm, without concomitant tissue proliferation. 33 In this context, the rational for implantation of the novel designed valved conduit as pulmonary valve substitute in GUCH patients was the avoidance of direct contact of the stentless xenograft with the RVOT muscle component by an already described surrounding vascular prosthesis. The current literature has pointed out significantly higher pressure gradients across the stentless xenografts in GUCH patients at 1-year follow-up compared with homografts.…”