Pulmonary homograft dysfunction after the Ross procedure using decellularized homografts-a multicenter study

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• Pulmonary homograft dysfunction limits outcomes following the Ross procedure.
• Decellularized pulmonary homografts offer a potential solution to mitigate this complication.
• The Canadian Ross Registry provides valuable data for evaluating homograft performance.

Purpose of the Study:

• To determine the incidence, predictors, progression, and morphology of pulmonary homograft dysfunction.
• To assess the long-term outcomes of decellularized cryopreserved pulmonary homografts in Ross procedure patients.
• To identify risk factors associated with pulmonary homograft dysfunction.

Main Methods:

• Analysis of 466 patients undergoing the Ross procedure with decellularized cryopreserved pulmonary homografts (SynerGraft SG) from 2011-2019.
• Pulmonary homograft dysfunction defined by peak gradient ≥30 mm Hg, regurgitation >2, or reintervention.
• Comparison of patients with dysfunction (n=30) versus those without (n=436), with a median follow-up of 2.2 years.

Main Results:

• Cumulative incidence of pulmonary homograft dysfunction was 11% at 6 years, with stenosis being the most common presentation (93%).
• Cumulative incidence of homograft reintervention was 3% at 6 years, with the highest risk in the first postoperative year.
• Younger patient age (<45 years) was the sole independent risk factor for pulmonary homograft dysfunction (HR 3.1, P=.03).

Conclusions:

• Decellularized cryopreserved pulmonary homografts demonstrate a low incidence of dysfunction and reintervention after the Ross procedure.
• The risk of pulmonary homograft dysfunction is highest during the first year post-surgery.
• Younger age is identified as the primary independent risk factor for pulmonary homograft dysfunction.