Increased pulmonary flow velocities in oversized homografts in patients after the Ross procedure

• Published in: European journal of cardio-thoracic surgery 1997-10, Vol.12 (4), p.569-572
• Main Authors: MOIDL, R, SIMON, P, KUPILIK, N, CHEVTCHIK, O, HEINRICH, N, MORITZ, A, WOLNER, E, LAUFER, G
• Format: Article
• Language: English
• Subjects: Adult; Aortic Valve - surgery; Biological and medical sciences; Blood Flow Velocity; Cryopreservation; Echocardiography, Doppler; Female; Graft Rejection; Humans; Male; Medical sciences; Pulmonary Artery - physiopathology; Pulmonary Circulation - physiology; Pulmonary Valve - diagnostic imaging; Pulmonary Valve - physiopathology; Pulmonary Valve - transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Transplantation, Autologous; Transplantation, Homologous; Ventricular Outflow Obstruction - surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)00212-1

OBJECTIVE: Between September 1991 and July 1996, 60 patients (mean age 29.8 ± 9 years; range 5-57) underwent aortic root replacement with pulmonary autograft, a viable biologic and non degenerating substitute. The pulmonary root was replaced with cryopreserved homografts from cardiac transplant recipients. The aim of this study was to evaluate differences in early valve function of viable and cryopreserved allografts. METHODS: Allpatients had Doppler echocardiographic examinations preoperatively, at discharge from hospital and 54 patients at 1 year follow-up. We measured aortic and pulmonary peak flow velocities with continuous and pulsed-wave Doppler, and graded aortic and pulmonary insufficiency (AI, PI) with color Doppler flow (grade 0- IV). Intraoperatively, the diameters of the pulmonary root and the pulmonary homograft were measured with standardvalve probes and matched to body surface area. RESULTS: Pulmonary peak flowvelocity (PVmax) increased significantly from preoperative 0.87 ± 0.11 m/s to 1.30 ± 0.34 m/s postoperatively (P < 0.001). The implanted homografts (mean 25.9 ± 2.4 mm) were larger than their native pulmonary diameter (mean 23.3 ± 1.8 mm) in all patients. Homograft size matched for body surface area (BSA) did not correlate with increased PVmax. There was asignificant increase of PVmax at follow-up (FU) since discharge, also (1.83± 0.53 m/s; P < 0.001). Pulsed-wave Doppler demonstrates that increaseof PVmax is located directly at the homograft leaflets and not at the anastomoses. Aortic peak flow velocities (AVmax) were normal postoperatively and at FU (post = 1.35 ± 0.35 m/s; FU = 1.17 ± 0.27m/s). There was no significant change in AI or PI since discharge (AI FU =0.8 ± 0.4; PI FU = 0.7 ± 0.5). Eight patients with fever and symptoms diagnosed as post-pericardiotomy syndrome had significantly higher PVmax at FU (PVmax = 2.41 ± 0.40 m/s; P < 0.02). CONCLUSIONS: The Rossprocedure leads to normal AVmax but significant increase of PVmax even inoversized cryopreserved homografts immediately after surgery. Further increase of PVmax without changes in AVmax in the first year demonstratesthat changes in flow velocities are valve related and not due to increasein cardiac output. Further investigations will be necessary to determine whether this observation is due to valve rejection or early leaflet degeneration and treatment with immunosuppressive therapy is warranted.