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J Thorac Cardiovasc Surg 2009;138:84-88
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

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

^a UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom
^b The Heart Hospital, London, United Kingdom

Received for publication April 8, 2008; revisions received July 1, 2008; accepted for publication August 2, 2008.

^_* Address for reprints: Philipp Bonhoeffer, MD, Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK. (Email: BonhoP{at}gosh.nhs.uk).

Objective: 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.

Methods: 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.

Results: 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 · beat^–1 · m^–2, P < .01) and maximal cardiopulmonary exercise performance improved (peak oxygen consumption 25.4 ± 2.3 to 30.8 ± 3.0 mL · kg^–1 · 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.

Conclusions: 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.

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