Effective transcatheter valve implantation after pulmonary homograft failure: a new perspective on the Ross operation.

Abstract

The Ross procedure offers good autograft function and low reoperation rates for the neoaortic valve; however, the rate of conduit dysfunction in the right ventricular outflow tract remains a concern. This study assessed percutaneous pulmonary valve implantation in this setting. We retrospectively analyzed outcomes of 12 patients (mean age 28 +/- 5 years) referred for percutaneous pulmonary valve implantation to treat right ventricle-pulmonary artery conduit failure 11.1 +/- 3.3 years after Ross procedure. Percutaneous pulmonary valve implantation was feasible in all 12 patients, with no procedural complications (procedure time 99 +/- 16 minutes, fluoroscopy time 21 +/- 6 minutes). Right ventricular outflow tract gradient during catheterization and pulmonary regurgitant fraction on magnetic resonance imaging fell after valve implantation (gradient 34 +/- 6 to 14 +/- 3 mm Hg, P < .01, regurgitant fraction 20% +/- 6% to 2% +/- 1%, P < .05). After restoration of right ventricular outflow tract function, indexed right ventricular end-diastolic volume decreased (91 +/- 13 to 78 +/- 12 mL x beat(-1) x m(-2), P < .01) and maximal cardiopulmonary exercise performance improved (peak oxygen consumption 25.4 +/- 2.3 to 30.8 +/- 3.0 mL x kg(-1) x min(-1), P < .01). During follow-up (18.8 +/- 4.6 months), there was 1 device explantation (restenosis). The probabilities of freedom from right ventricular outflow tract reoperation were 100% at 1 year and 90% at 3 years. Percutaneous pulmonary valve implantation provides an effective transcatheter treatment strategy to prolong the lifespan of right ventricle-pulmonary artery conduits after the Ross procedure, reducing the reoperation burden on patients with aortic valve disease.