Pulmonary Homograft vs Handmade Polytetrafluoroethylene-Valved Conduits After the Ross Procedure

Carlos E Diaz-Castrillon; Melita Viegas; Mario Castro-Medina; Kristian Punu; Shwetabh Tarun; Luciana DaSilva Da Fonseca; Victor Morell

doi:10.1016/j.athoracsur.2023.06.024

Pulmonary Homograft vs Handmade Polytetrafluoroethylene-Valved Conduits After the Ross Procedure

Ann Thorac Surg. 2023 Nov;116(5):980-986. doi: 10.1016/j.athoracsur.2023.06.024. Epub 2023 Jul 8.

Authors

Carlos E Diaz-Castrillon¹, Melita Viegas², Mario Castro-Medina¹, Kristian Punu³, Shwetabh Tarun³, Luciana DaSilva Da Fonseca¹, Victor Morell¹

Affiliations

¹ Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
² Division of Pediatric Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: viegasml@upmc.edu.
³ Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.

PMID: 37429515
DOI: 10.1016/j.athoracsur.2023.06.024

Abstract

Background: This study aimed to longitudinally compare expanded polytetrafluoroethylene (ePTFE)-valved conduits vs pulmonary homograft (PH) conduits after right ventricular outflow tract reconstruction in the Ross procedure.

Methods: Patients undergoing a Ross procedure from June 2004 to December 2021 were identified. Echocardiographic data, catheter-based interventions, or conduit replacements, as well as time to first reintervention or replacement, were comparatively assessed between handmade ePTFE-valved conduits and PH conduits.

Results: A total of 90 patients were identified. The median age and weight were 13.8 years (interquartile range [IQR], 8.08-17.80 years) and 48.3 kg (IQR, 26.8-68.7 kg), respectively. There were 66% (n = 60) ePTFE-valved conduits and 33% (n = 30) PHs. The median size was 22 mm (IQR, 18-24 mm) for ePTFE-valved conduits and 25 mm (IQR, 23-26 mm) for PH conduits (P < .001). Conduit type had no differential effect in the gradient evolution or the odds of presenting with severe regurgitation in the last follow-up echocardiogram. Of the 26 first reinterventions, 81% were catheter-based interventions, without statistically significant differences between the groups (69% PH vs 83% ePTFE). The overall surgical conduit replacement rate was 15% (n = 14), and it was higher in the homograft group (30% vs 8%; P = .008). However, conduit type was not associated with an increased hazard for reintervention or reoperation after adjusting for covariates.

Conclusions: Right ventricular outflow tract reconstruction using handmade ePTFE-valved conduits after a Ross procedure provides encouraging midterm results, without a differential effect in hemodynamic performance or valve function compared with PH conduits. These results are reassuring about the use of handmade valved conduits in pediatric and young adult patients. Longer follow-up of tricuspid conduits will complement valve competency assessment.