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Transcatheter versus surgical valve replacement for a failed pulmonary homograft in the Ross population.
J Thorac Cardiovasc Surg. 2018 04; 155(4):1434-1444.JT

Abstract

BACKGROUND

Patients who undergo the Ross procedure are at increased risk of pulmonary valve (PV) homograft dysfunction. For those who require reintervention on the homograft, transcatheter PV replacement (tPVR) provides a less invasive therapeutic option than surgical PVR (sPVR). We examined the outcomes following tPVR versus sPVR in a cohort of patients who underwent the Ross procedure.

METHODS

We performed a retrospective analysis of Ross patients age ≥14 years who underwent tPVR (n = 47) or sPVR (n = 41) at our institution. The patients' clinical and echocardiographic data were reviewed.

RESULTS

Baseline parameters, including demographic data and left ventricular and right ventricular (RV) systolic function, were similar in the 2 groups. The mean follow-up was 56 ± 24 months for the tPVR group and 89 ± 46 months for the sPVR group (P < .001). No procedure-related mortality was noted in either group. At 6-year follow-up, there was no significant between-group difference in event-free survival (tPVR, 79% ± 7% vs sPVR, 91% ± 4%; P = .15) or PV reintervention (tPVR, 26% ± 9% vs sPVR, 8% ± 5%; P = .31). PV-associated infective endocarditis (IE) was significantly more common with tPVR (tPVR, 13% vs sPVR, 0%; P = .04), with an annualized rate of 2.98% per patient-year. In addition, there was a trend toward more valve dysfunction following sPVR (sPVR, 67% ± 8% vs tPVR, 35% ± 8%; P = .08).

CONCLUSIONS

In Ross patients who require reintervention on the PV homograft, both tPVR and sPVR provide low procedural mortality and comparable midterm outcome with no significant difference in mortality or PV reintervention. However, IE is more common following tPVR. A larger randomized study is needed to determine the role of each procedure in patient management.

Authors+Show Affiliations

Sections of Adult Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.Sections of Adult Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Cardiology, Dupuytren University Hospital, Limoges, France.Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.Sections of Adult Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.Sections of Adult Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.Cardiac Surgery, Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.Sections of Adult Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Electronic address: fadelbahaa@gmail.com.

Pub Type(s)

Comparative Study
Journal Article
Webcast

Language

eng

PubMed ID

29395212

Citation

Alassas, Khadija, et al. "Transcatheter Versus Surgical Valve Replacement for a Failed Pulmonary Homograft in the Ross Population." The Journal of Thoracic and Cardiovascular Surgery, vol. 155, no. 4, 2018, pp. 1434-1444.
Alassas K, Mohty D, Clavel MA, et al. Transcatheter versus surgical valve replacement for a failed pulmonary homograft in the Ross population. J Thorac Cardiovasc Surg. 2018;155(4):1434-1444.
Alassas, K., Mohty, D., Clavel, M. A., Husain, A., Hijji, T., Aljoufan, M., Alhalees, Z., & Fadel, B. M. (2018). Transcatheter versus surgical valve replacement for a failed pulmonary homograft in the Ross population. The Journal of Thoracic and Cardiovascular Surgery, 155(4), 1434-1444. https://doi.org/10.1016/j.jtcvs.2017.10.141
Alassas K, et al. Transcatheter Versus Surgical Valve Replacement for a Failed Pulmonary Homograft in the Ross Population. J Thorac Cardiovasc Surg. 2018;155(4):1434-1444. PubMed PMID: 29395212.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcatheter versus surgical valve replacement for a failed pulmonary homograft in the Ross population. AU - Alassas,Khadija, AU - Mohty,Dania, AU - Clavel,Marie Annick, AU - Husain,Aysha, AU - Hijji,Talal, AU - Aljoufan,Mansour, AU - Alhalees,Zohair, AU - Fadel,Bahaa M, Y1 - 2017/12/06/ PY - 2017/05/03/received PY - 2017/09/29/revised PY - 2017/10/30/accepted PY - 2018/2/6/pubmed PY - 2019/9/24/medline PY - 2018/2/4/entrez KW - Ross procedure KW - outcome KW - reintervention KW - transcatheter pulmonary replacement SP - 1434 EP - 1444 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 155 IS - 4 N2 - BACKGROUND: Patients who undergo the Ross procedure are at increased risk of pulmonary valve (PV) homograft dysfunction. For those who require reintervention on the homograft, transcatheter PV replacement (tPVR) provides a less invasive therapeutic option than surgical PVR (sPVR). We examined the outcomes following tPVR versus sPVR in a cohort of patients who underwent the Ross procedure. METHODS: We performed a retrospective analysis of Ross patients age ≥14 years who underwent tPVR (n = 47) or sPVR (n = 41) at our institution. The patients' clinical and echocardiographic data were reviewed. RESULTS: Baseline parameters, including demographic data and left ventricular and right ventricular (RV) systolic function, were similar in the 2 groups. The mean follow-up was 56 ± 24 months for the tPVR group and 89 ± 46 months for the sPVR group (P < .001). No procedure-related mortality was noted in either group. At 6-year follow-up, there was no significant between-group difference in event-free survival (tPVR, 79% ± 7% vs sPVR, 91% ± 4%; P = .15) or PV reintervention (tPVR, 26% ± 9% vs sPVR, 8% ± 5%; P = .31). PV-associated infective endocarditis (IE) was significantly more common with tPVR (tPVR, 13% vs sPVR, 0%; P = .04), with an annualized rate of 2.98% per patient-year. In addition, there was a trend toward more valve dysfunction following sPVR (sPVR, 67% ± 8% vs tPVR, 35% ± 8%; P = .08). CONCLUSIONS: In Ross patients who require reintervention on the PV homograft, both tPVR and sPVR provide low procedural mortality and comparable midterm outcome with no significant difference in mortality or PV reintervention. However, IE is more common following tPVR. A larger randomized study is needed to determine the role of each procedure in patient management. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/29395212/Transcatheter_versus_surgical_valve_replacement_for_a_failed_pulmonary_homograft_in_the_Ross_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(17)32770-8 DB - PRIME DP - Unbound Medicine ER -