RESUMO
AIMS: The aim of this study was to evaluate the impact of rheumatic heart disease (RHD) on the long-term outcomes of the Ross operation when compared to patients with bicuspid aortic valves (BAV). METHODS AND RESULTS: We analysed patients with rheumatic disease and BAV who underwent a Ross operation between 1995 and 2020. The primary outcomes were late survival and reoperations on the pulmonary autograft and the right ventricular allograft. We also performed a propensity score analysis to adjust for differences in baseline characteristics. The cumulative incidence of the events in the matched cohorts was compared using the Fine-Gray model. There were 147 patients with rheumatic disease and 314 with bicuspid valves. In the unmatched population, patients with rheumatic disease were younger, more symptomatic, had worse left ventricular function and were more likely to present a preoperative diagnosis of aortic insufficiency. Propensity matching resulted in 86 pairs with similar baseline characteristics. Compared with those with bicuspid valves, rheumatic patients had similar 20-year survival both in the unmatched (RHD = 67.8% vs BAV = 79.7%, P = 0.27] and matched cohorts (RHD = 72.5% vs BAV = 82.9%, P = 0.46). Cumulative incidence of reoperations on the pulmonary autograft after 20 years was also comparable between them in the unmatched (RHD 13.4% vs BAV 14.4%, P = 0.67) and matched patients (RHD 11.6% vs BAV 21.1%, P = 0.47). Pulmonary autograft dysfunction due to rheumatic involvement was detected in only three occasions. Cumulative incidence of reoperations on the right-sided allograft was higher in the unmatched cohort (RHD = 5.5% vs BAV = 16.7%, P = 0.035) but became nonsignificant after propensity score matching (RHD = 9.9% vs BAV = 32.3%, P = 0.051). The cumulative incidence of all Ross-related reoperations was similar in both groups. CONCLUSIONS: Among patients undergoing Ross operation, patients with RHD had similar long-term survival and rates of reoperations, when compared to patients with BAV.
Assuntos
Estenose da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Valva Pulmonar , Doenças Reumáticas , Cardiopatia Reumática , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Autoenxertos , Doenças das Valvas Cardíacas/cirurgia , Humanos , Valva Pulmonar/transplante , Estudos Retrospectivos , Cardiopatia Reumática/complicações , Cardiopatia Reumática/cirurgia , Transplante Autólogo , Resultado do TratamentoRESUMO
This study evaluated cryopreserved homografts (Group 1) and porcine heterografts decellularized with deoxicholic acid (Group 2), implanted in the right ventricular outflow tract of juvenile sheep. Two groups with four animals in each were used and all animals survived with good outcome. Animals were sacrificed 90 or more days after surgery (90-150 days). On the third and fifth postoperative months they were submitted to echocardiographic examination with normal function and appearance observed for both groups. Explants were evaluated through histological analysis, atomic spectrophotometry and radiological examination. Calcium content was higher in the cusps of cryopreserved homografts, despite an otherwise similar macroscopic appearance between grafts of both groups. Decellularized heterografts were progressively repopulated by autologous cells suggesting some regenerative ability and longer durability than conventional homografts.