Objective
Since first Ross operation many investigators have been founding homograft-related factors influencing follow-up after surgery. The goal of this study was to establish echocardiographical and radiological factors identifying natural dynamic of pulmonary stenosis in mid and long-term follow-up and predicting postoperative outcome.
Methods
We followed up 86 patients (mean age, 9,6 ± 2,7 years) who had Ross or Konno-Ross procedure by transthoracic echocardiography and 64-slice CT. There were 45 pts below 15 yrs of age. Follow-up was 6 ± 3 years and was 100% complete. Cryopreserved homografts were implanted to reconstruct RVOT during Ross operation. Up-to-size homografts were applied as a rule in children to avoid early replacement. Allograft stenosis was analyzed and risk factors were identified by univariate, multivariate, and survival analysis methods. Stenosis was defined as a mean ECHO gradient greater or equal to 20 mm Hg.
Results
There was no reoperation for homograft stenosis during available mid-term( 45 pts ) and late (30 pts )follow-up. Stenosis-free survival was 85 ± 5% and 80 ± 7% after 3-5 and above 5 years, respectively. As independent predictor for stenosis transhomograft gradient greater than 10mm Hg 1 year after procedure was revealed. Oversizing of homograft wasn’t risk factor for stenosis. A cut-off value of 10 mm Hg at 1 year of follow-up could predict occurrence of stenosis.
Conclusions
Homograft oversizing and age of recipient aren’t important factors for pulmonary stenosis after Ross operation. Echocardiographic transhomograft gradient more than 10mm Hg in early follow-up might predict occurance of stenosis.