Predictive Factors for Pulmonary Homograft Dysfunction After Ross Surgery: A 20-year Follow-up.

Abstract Background We studied the determinants of hemodynamics and analyzed the incidence, risk factors, and clinical impact of pulmonary homograft dysfunction following Ross surgery, after a 20-year follow-up at our referral center. Methods From 1997 to 2017, a total of 142 patients underwent surgery using the Ross procedure. The development of moderate-severe stenosis (peak transhomograft pressure gradient ≥ 36 mmHg), and surgical and/or percutaneous Ross homograft reinterventions, were evaluated by echocardiography in the immediate postoperative period and at annual intervals. Results After 20 years of follow-up, 31% of patients had developed moderate-severe homograft stenosis, and 9.1% had had to undergo one or two reinterventions, of which, six were valve replacements, and seven were percutaneous interventions. At 1, 5, and 20 years, 89.4%, 74.6%, and 69% of these patients, respectively, were free from moderate-severe stenosis, and 99.3%, 95.7%, and 90.9%, respectively, had freedom from homograft reintervention. The pediatric group had a higher risk factor for homograft stenosis (hazard ratio [HR]:3.70; 95% confidence interval [CI]:1.56-7.20, p= 0.002), while donor age behaved as a protective factor (HR:0.98; 95%CI: 0.95-0.99, p= 0.044). Pulmonary homograft stenosis tended to appear in the first year (10.6%) or at 5 years (25.4%). Conclusions Pulmonary homografts implanted in the Ross procedure offer satisfactory long-term results, but the level of homograft dysfunction is not negligible. Young recipient and donor age were associated with a higher rate of homograft stenosis during follow-up. Moreover, homograft dysfunction usually occurred during the first few years of follow-up, which may have been related to immune responses.