Durability of right ventricular conduits in the Ross procedure

Abstract

Background: Right ventricular (RV) conduit availability and degeneration are po tential limitations of the Ross procedure. Pulmonary homografts are the gold stan dard, but their limited availability drives the need for alternatives. The aim of this study was to compare results of different RV conduits. Methods: Between 1995 and 2023, 315 consecutive patients (73% males; mean age, 37 12 years) underwent a Ross procedure using a homograft (n ¼ 211), bovine jugular vein (BJV) (n ¼ 34), or xenograft (n ¼ 70) as the RV conduit. The mean follow-up was 5.7 6.7 years and was 96% complete (1631 patient-years). Results: Twelve patients (homograft, n ¼ 8; BJV. n ¼ 3; xenograft, n ¼ 1) required RV conduit reintervention, including 4 patients within 4 years (all with homografts). Indica tions for reintervention were degeneration in 8 patients and active endocarditis in 4 pa tients. Reinterventions included RV conduit replacement (homograft, n ¼ 3; xenograft, n¼ 1; BJV, n¼ 2) and transcatheter valve implantation (homograft n¼ 5; BJV, n¼ 1). At 15 years, freedom from RV conduit reintervention was 88%, and freedom from reop eration was 93%. Freedom from reintervention at 15 years was similar in the homograft (89%), BJV (89%), and xenograft (100%) groups (P ¼ .812). Progression of mean RV conduit gradient was lowest for the BJV group (1.45 mm Hg/year) and similar in the ho mograft (2.6 mm Hg/year) and xenograft (2.9 mm Hg/year) groups. Age at<18 years at surgery (hazard ratio [HR], 1.9; P<.001) was a predictive risk factor for reintervention. There was no difference among the RV conduit groups (HR, 1.198; P ¼ .606). Conclusions: The incidence of reintervention after 15 years is similar in recipients of homografts, xenografts, and BJV grafts. Interestingly, homografts may fail in the first few years, possibly related to inflammatory phenomena. Thus, the use of xeno grafts may be an option if homografts are not available. (J Thorac Cardiovasc Surg 2025;169:1306-14)