Right Ventricular Outflow Tract Replacement With Xenografts in Ross Patients Older Than 60 Years

Because of the limited availability of pulmonary allografts, stentless pericardial xenografts have been proposed as an alternative for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure. However, the durability of the bioprostheses for RVOT reconstruction in older patients is unknown. In the present study, we evaluated the use of pericardial xenografts for RVOT reconstruction during the Ross procedure in patients aged more than 60 years.

Between 1998 and 2014, 710 consecutive adult patients underwent the Ross procedure. We analyzed the results of the operation in 102 patients aged more than 60 years. The mean patient age was 63.4 ± 2.8 years (range, 60 to 68). The total root replacement technique was used in all patients. The RVOT reconstruction was performed with stentless pericardial xenografts. The mean size of the xenografts was 26.8 ± 1.3 mm. Xenograft calcification was assessed by computed tomography in 39 patients.

At the time of discharge, the RVOT peak gradient was 10.3 ± 3.5 mm Hg. The mean follow-up duration was 52.3 ± 23.6 months. None of the cases required reoperation for xenograft dysfunction. At the final follow-up, the RVOT peak gradient was 17.9 ± 4.3 mm Hg. Computed tomography scan analyses showed that calcification was localized mainly at the graft wall, and that the valve was relatively free of calcium.

Stentless diepoxide-treated pericardial xenografts are an acceptable alternative to pulmonary allografts for RVOT reconstruction with the Ross procedure in patients aged more than 60 years, and yield good midterm results.