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Updated: Feb 14, 2026

A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
Accelerated acute severe antibody-mediated graft failure related to a Ross procedure 17 years earlier
Martin Andreas1, Kathrin Freystaetter1, Martin H Bernardi2
1Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Abstract:
A 31-year-old male patient underwent a heart transplantation due to dilated cardiomyopathy. He experienced accelerated acute antibody-mediated rejection despite being negative for human leukocyte antigen antibodies (0% panel-reactive antibodies prior to surgery). Further assessment revealed a common antigen between a homograft implanted 17 years earlier during the Ross procedure and the heart donor. The homograft likely induced specific antibody formation. Interestingly, panel-reactive antibody levels measured 7 years prior to transplantation were 7%. Because of the long time span between the Ross procedure and heart transplantation, no circulating antibodies could be detected in 2015, but reactivation of memory cells might potentially have led to this fulminant rejection episode. For future cases, particular attention should be given to patients with homografts.
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