Stentless xenografts and homografts for right ventricular outflow tract reconstruction during the Ross operation

Shortage of homografts prompted us to replace the transplanted pulmonary trunk with stentless xenografts during the Ross procedure. The 5-year follow-up in comparison with pulmonary homografts is presented.

From April 1997 to March 2002, of 51 patients undergoing a modified Ross procedure 15 patients (age range 55 to 65 years, mean 59 +/- 5) received a stentless xenograft, and 36 patients (15 to 56 years, mean 36 +/- 11) a pulmonary homograft for right ventricular outflow tract (RVOT) reconstruction. Follow-up was complete for a mean of 3.1 years (range 6 to 60). Regularly performed echocardiography included determination of valve annulus, peak instantaneous gradient, leaflet performance, location of obstruction, and degree of regurgitation.

There was 1 late death and 1 reoperation for homograft stenosis. The homograft annulus diameter decreased by a mean of 10% (range 3 to 10 mm; p < 0.01), and peak Doppler gradient increased significantly (p < 0.001). All patients except 1 had gradients less than 25 mm Hg. Gradients in xenograft patients were stable at a low level (6.5 +/- 4.3 mm Hg to 8.8 +/- 7.4 mm Hg at the latest follow-up). Mild pulmonary regurgitation was noted in 46.6% (xenografts) and 19.5% (homografts). Leaflet quality and mobility were maintained in all patients.

Pulmonary homografts underlie a process of annular reduction after the Ross procedure, which is usually not associated with graft stenosis. Mild pulmonary regurgitation is more common in xenografts than in homografts. RVOT reconstruction using stentless xenografts represents a satisfactory treatment modality for aged patients.