Predictive Factors for Pulmonary Homograft Dysfunction After Ross Surgery: A 20-Year Follow-up

Carbonell, Azahara Fernández; Rodríguez-Guerrero, Enrique; Merino-Cejas, Carlos; Conejero-Jurado, María Teresa; Villalba-Montoro, Rafael; Romero-Morales, María del Carmen; Alados-Arboledas, Pedro; Casares-Mediavilla, Jaime; Fernández-Carbonell, Marta; López‐Cillero, Pedro; Caro-Barrera, José Rafael

doi:10.1016/j.athoracsur.2020.06.032

Cited by 4 publications

(1 citation statement)

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“…Heart valve transplantation is a potential novel treatment for young children with unrepairable severe heart valve disease 4 . The transplanted valve could potentially grow with the patient similar to growth of pulmonary autografts and paediatric heart transplants, and thus, potentially eliminate the need for serial mechanical or bioprosthetic valve replacements during childhood to accommodate growth and valve degeneration 10,11 . Heart valve transplants differ from homografts by measures taken to maintain viability of the donor cells in the valve replacement, namely ABO matching the donor, controlling the ischaemic injury to the graft, and immune suppression of the recipient similar to orthotopic heart transplants.…”

Section: Discussionmentioning

confidence: 99%

Effect of cardiac graft rejection on semilunar valve function: implications for heart valve transplantation

et al. 2022

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Background: The treatment of neonates with unrepairable heart valve dysfunction remains an unsolved problem because there are no growing heart valve replacements. Heart valve transplantation is a potential approach to deliver growing heart valve replacements. Therefore, we retrospectively analysed the semilunar valve function of orthotopic heart transplants during rejection episodes. Methods: We included children who underwent orthotopic heart transplantation at our institution and experienced at least one episode of rejection between 1/1/2010 and 1/1/2020. Semilunar valve function was analysed using echocardiography at baseline, during rejection and approximately 3 months after rejection. Results: Included were a total of 31 episodes of rejection. All patients had either no (27) or trivial (4) aortic insufficiency prior to rejection. One patient developed mild aortic insufficiency during a rejection episode (P = 0.73), and all patients had either no (21) or trivial (7) aortic insufficiency at follow-up (P = 0.40). All patients had mild or less pulmonary insufficiency prior to rejection, which did not significantly change during (P = 0.40) or following rejection (P = 0.35). Similarly, compared to maximum pressure gradients across the valves at baseline, which were trivial, there was no appreciable change in the gradient across the aortic valve during (P = 0.50) or following rejection (P = 0.42), nor was there any meaningful change in the gradient across the pulmonary valve during (P = 0.55) or following rejection (P = 0.91). Conclusions: This study demonstrated that there was no echocardiographic evidence of change in semilunar valve function during episodes of rejection in patient with heart transplants. These findings indicate that heart valve transplants require lower levels of immune suppression than orthotopic heart transplants and provide partial foundational evidence to justify future research that will determine whether heart valve transplantation may deliver growing heart valve replacements for children.

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Section: Discussionmentioning

confidence: 99%