Homograft Performance in 84 Pediatric Ross Patients - Results from the German-Dutch Ross Registry

  • Jürgen Hörer, Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany, Germany
  • Julie Cleuziou, Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany, Germany
  • Thorsten Hanke, Department of Cardiac Surgery, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany, Germany
  • Johanna Takkenberg, Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands, The Netherlands
  • Ulrich Stierle, Department of Cardiac Surgery, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany, Germany
  • Hans Sievers, Department of Cardiac Surgery, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany, Germany
  • Rüdiger Lange, Department of Cardiac Surgery, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany, Germany

    • Background: The Ross operation may be the ideal aortic valve replacement in pediatric patients. However, reoperations for replacement of the homograft (HG) in the pulmonary position are inevitable. This study was conducted to determine influencing factors for the development of homograft stenosis (HS) and regurgitation (HR) in an international pediatric Ross operated cohort.
    Methods: Prospectively collected data of 84 children <16 years of age at the time of the Ross operation (62 m, 22 f, mean age 9.4±5.0 years), were analyzed using hierarchical multilevel modeling. Mean follow-up was 6.5±4.2 years.
    Results: Median HG diameter z-value was 0.2 (range -2.2 to +7.3). Mean HG pressure gradient at implantation was 5.1 mmHg with a significant annual increase of 4.1 mmHg/year (p<0.001). Higher donor age was significantly associated with lower mean pressure gradient at implantation (p=0.037). Larger z-value had no significant influence on the annual increase of HG (p=0.87). Mean HR at implantation was 0.9 without significant annual increase (0.02 grade/year, p=0.35). Higher recipient age (p=0.002), and higher donor age (p<0.0001) were significantly associated with lower mean HR at implantation. However, larger z-value (p=0.014) was significantly associated with a higher annual increase of HR.
    Conclusion: Relevant HR is rare in the midterm in children following the Ross Operation. However, there is significant annual increase in HG pressure gradient which is not influenced by the use of larger grafts upon initial operation. In contrast, oversizing of the HG may lead to a higher annual increase of HR.