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May 23, 2012European Journal of Cardio-Thoracic SurgeryOpen Access

Comparison between homografts and Freestyle(R) bioprosthesis for right ventricular outflow tract replacement in Ross procedures

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Key result

Stentless bioprostheses for RVOT replacement after the Ross procedure had a higher incidence of reintervention compared to homografts (1 in 36 vs 1 in 150 patient years; P=0.007).

Why the study?

Does RVOT replacement with stentless bioprostheses compared to homografts increase the risk of reintervention in adult patients undergoing the Ross procedure?

Population

186 adult patients undergoing aortic root replacement with a pulmonary autograft

Comparison

Right ventricular outflow tract replacement with… vs Right ventricular outflow tract replacement with…

Design

Cohort

Follow-up

mean 6 years (range 1-15 years)

Authors

AMAleksandra MiskovicNMNadejda MonsefiMDMirko Doss

Discussion

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Member takes

Overview

Bioprosthetics may serve as alternative to homografts for adult Ross RVOT reconstruction; leaves open need for randomized durability data.

Study Design

Type

Cohort (n=186)

Structured PICO

Does RVOT replacement with stentless bioprostheses compared to homografts increase the risk of reintervention in adult patients undergoing the Ross procedure?

P
Population
186 adult patients (mean age 44 years, 24% female) undergoing the Ross procedure with RVOT replacement, followed for a mean of 6 years.
E
Exposure
Right ventricular outflow tract (RVOT) replacement with stentless bioprostheses
C
Comparator
Right ventricular outflow tract (RVOT) replacement with a homograft
O
Outcome
Reintervention owing to dysfunction of the RVOT replacementhard clinical

Main Result

p-value: p=0.007

In adult patients undergoing the Ross procedure, RVOT replacement with stentless bioprostheses is associated with a significantly higher risk of reintervention and higher gradients compared to homografts.

Cite This Study

Miskovic et al. (2012) conducted a cohort in Right ventricular outflow tract replacement in Ross procedures (n=186). Stentless bioprostheses (Medtronic Freestyle) vs. Homograft was evaluated on Incidence of reintervention owing to dysfunction of the RVOT replacement (p=0.007). Stentless bioprostheses for RVOT replacement after the Ross procedure had a higher incidence of reintervention compared to homografts (1 in 36 vs 1 in 150 patient years; P=0.007).

synapsesocial.com/papers/6a63d688f3f956990ff2dea2https://doi.org/10.1093/ejcts/ezs185
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Long-term outcome of right ventricular outflow tract reconstruction with bicuspidalized homografts2011 · 14 citations
  2. 2Long-term follow-up of supra-annular pulmonary autograft aortic root replacement in patients with bicuspid aortic valve☆2008 · 12 citations
  3. 3Reconstruction of the RVOT with valved biological conduits: 25 years experience with allografts and xenografts✩2000 · 201 citations
  4. 4Clinical outcome and health-related quality of life after right-ventricular-outflow-tract reconstruction with an allograft conduit☆☆☆2010 · 31 citations
  5. 5The Ross operation — a feasible and safe option in the setting of a bicuspid aortic valve?2010 · 33 citations