Download PDF
Thorac Cardiovasc Surg 2019; 67(01): 014-020
DOI: 10.1055/s-0038-1668595
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

External Prosthetic Reinforcement of the Pulmonary Autograft

Thomas Ratschiller
1   Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Eva Sames-Dolzer
1   Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Wolfgang Schimetta
2   Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
,
Michaela Kreuzer
1   Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Hannes Müller
1   Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Andreas Zierer
1   Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Rudolf Mair
1   Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
› Author Affiliations
Further Information

Publication History

16 April 2018

05 July 2018

Publication Date:
28 August 2018 (online)

    Permissions and Reprints All articles of this category

Abstract

Background Neo-aortic root dilatation accounts for the majority of reoperations needed after the Ross procedure with implantation of the pulmonary autograft as complete root replacement. This study evaluates early results of external prosthetic reinforcement of the autograft.

Methods From July 2015 to October 2017, 16 adolescent and adult patients received a Ross procedure at our department by this technique. A congenital-dysplastic valve was present in 13 patients, including 9 patients with a bicuspid aortic valve. Clinical and echocardiographic follow-up is complete with a mean duration of 19.7 ± 5.8 months.

Results The mean age at operation was 27.1 ± 16.1 years. Mean aortic cross-clamping time was 102 ± 39 minutes. No bleeding complication occurred. The median stay on the intensive care unit was 2 days. In-hospital mortality was 0%. All patients were discharged with no or trivial aortic regurgitation. In one patient both the autograft and homograft were replaced because of endocarditis 3 months after the primary operation, leading to 93.8% freedom from reoperation at 2 years. There were no late deaths during the study period. The latest echocardiography confirmed absence of aortic regurgitation grade >I in all patients. Neo-aortic root diameters remained stable during follow-up.

Conclusion The presented modification of the Ross procedure does not prolong ischemia time, and can be performed with a low operative morbidity and mortality and an excellent early valve function.

Keywords

Ross - pulmonary autograft - AG dilatation
 

  • References

  • 1 Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 1967; 2 (7523): 956-958
    PubMedGoogle Scholar
  • 2 Sievers HH, Schmidtke C, Graf B. Hemodynamics of semilunar valves at rest and exercise at an average of more than two years after the Ross procedure. J Heart Valve Dis 2001; 10 (02) 166-169 , discussion 169–170
    PubMedGoogle Scholar
  • 3 Le Guillou V, Bouchart F, Gay A. , et al. The Ross procedure in endocarditis: a report of 28 cases. Eur J Cardiothorac Surg 2014; 45 (01) 153-158
    CrossrefPubMedGoogle Scholar
  • 4 Kouchoukos NT, Masetti P, Nickerson NJ, Castner CF, Shannon WD, Dávila-Román VG. The Ross procedure: long-term clinical and echocardiographic follow-up. Ann Thorac Surg 2004; 78 (03) 773-781 , discussion 773–781
    CrossrefPubMedGoogle Scholar
  • 5 Weimar T, Charitos EI, Liebrich M. , et al. Quo vadis pulmonary autograft--the ross procedure in its second decade: a single-center experience in 645 patients. Ann Thorac Surg 2014; 97 (01) 167-174
    CrossrefPubMedGoogle Scholar
  • 6 El-Hamamsy I, Eryigit Z, Stevens LM. , et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Lancet 2010; 376 (9740): 524-531
    CrossrefPubMedGoogle Scholar
  • 7 Andreas M, Wiedemann D, Seebacher G. , et al. The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting. Eur J Cardiothorac Surg 2014; 46 (03) 409-413 , discussion 413–414
    CrossrefPubMedGoogle Scholar
  • 8 Takkenberg JJ, Klieverik LM, Schoof PH. , et al. The Ross procedure: a systematic review and meta-analysis. Circulation 2009; 119 (02) 222-228
    CrossrefPubMedGoogle Scholar
  • 9 David TE, Omran A, Ivanov J. , et al. Dilation of the pulmonary autograft after the Ross procedure. J Thorac Cardiovasc Surg 2000; 119 (02) 210-220
    CrossrefPubMedGoogle Scholar
  • 10 Bekkers JA, Klieverik LM, Raap GB, Takkenberg JJ, Bogers AJ. Aortic root reoperations after pulmonary autograft implantation. J Thorac Cardiovasc Surg 2010; 140 (6, Suppl): S58-S63 , discussion S86–S91
    CrossrefPubMedGoogle Scholar
  • 11 Falk V, Baumgartner H, Bax JJ. , et al; ESC Scientific Document Group. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52 (04) 616-664
    CrossrefPubMedGoogle Scholar
  • 12 Akins CW, Miller DC, Turina MI. , et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Eur J Cardiothorac Surg 2008; 33 (04) 523-528
    CrossrefPubMedGoogle Scholar
  • 13 de Kerchove L, Rubay J, Pasquet A. , et al. Ross operation in the adult: long-term outcomes after root replacement and inclusion techniques. Ann Thorac Surg 2009; 87 (01) 95-102
    CrossrefPubMedGoogle Scholar
  • 14 Yacoub MH, Klieverik LM, Melina G. , et al. An evaluation of the Ross operation in adults. J Heart Valve Dis 2006; 15 (04) 531-539
    PubMedGoogle Scholar
  • 15 Rabkin-Aikawa E, Aikawa M, Farber M. , et al. Clinical pulmonary autograft valves: pathologic evidence of adaptive remodeling in the aortic site. J Thorac Cardiovasc Surg 2004; 128 (04) 552-561
    CrossrefPubMedGoogle Scholar
  • 16 Luciani GB, Casali G, Favaro A. , et al. Fate of the aortic root late after Ross operation. Circulation 2003; 108 (Suppl. 01) II61-II67
    PubMedGoogle Scholar
  • 17 Charitos EI, Hanke T, Stierle U. , et al; German-Dutch Ross Registry. Autograft reinforcement to preserve autograft function after the ross procedure: a report from the German-Dutch ross registry. Circulation 2009; 120 (11, Suppl): S146-S154
    CrossrefPubMedGoogle Scholar
  • 18 David TE, Woo A, Armstrong S, Maganti M. When is the Ross operation a good option to treat aortic valve disease?. J Thorac Cardiovasc Surg 2010; 139 (01) 68-73 , discussion 73–75
    CrossrefPubMedGoogle Scholar
  • 19 Settepani F, Kaya A, Morshuis WJ, Schepens MA, Heijmen RH, Dossche KM. The Ross operation: an evaluation of a single institution's experience. Ann Thorac Surg 2005; 79 (02) 499-504
    CrossrefPubMedGoogle Scholar
  • 20 Schneider U, Feldner SK, Hofmann C. , et al. Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg 2017; 153 (04) S65-S71
    CrossrefPubMedGoogle Scholar
  • 21 Pasquali SK, Cohen MS, Shera D, Wernovsky G, Spray TL, Marino BS. The relationship between neo-aortic root dilation, insufficiency, and reintervention following the Ross procedure in infants, children, and young adults. J Am Coll Cardiol 2007; 49 (17) 1806-1812
    CrossrefPubMedGoogle Scholar
  • 22 Liebrich M, Weimar T, Tzanavaros I, Roser D, Doll KN, Hemmer WB. The David procedure for salvage of a failing autograft after the Ross operation. Ann Thorac Surg 2014; 98 (06) 2046-2052
    CrossrefPubMedGoogle Scholar
  • 23 Luciani GB, Lucchese G, De Rita F, Puppini G, Faggian G, Mazzucco A. Reparative surgery of the pulmonary autograft: experience with Ross reoperations. Eur J Cardiothorac Surg 2012; 41 (06) 1309-1314 , discussion 1314–1315
    CrossrefPubMedGoogle Scholar
  • 24 Carrel T, Schwerzmann M, Eckstein F, Aymard T, Kadner A. Preliminary results following reinforcement of the pulmonary autograft to prevent dilatation after the Ross procedure. J Thorac Cardiovasc Surg 2008; 136 (02) 472-475
    CrossrefPubMedGoogle Scholar
  • 25 Juthier F, Banfi C, Vincentelli A. , et al. Modified Ross operation with reinforcement of the pulmonary autograft: six-year results. J Thorac Cardiovasc Surg 2010; 139 (06) 1420-1423
    CrossrefPubMedGoogle Scholar
  • 26 Al Rashidi F, Bhat M, Höglund P, Meurling C, Roijer A, Koul B. The modified Ross operation using a Dacron prosthetic vascular jacket does prevent pulmonary autograft dilatation at 4.5-year follow-up. Eur J Cardiothorac Surg 2010; 37 (04) 928-933
    CrossrefPubMedGoogle Scholar
  • 27 Sievers HH, Stierle U, Charitos EI. , et al. Fourteen years' experience with 501 subcoronary Ross procedures: surgical details and results. J Thorac Cardiovasc Surg 2010; 140 (04) 816-822 , 822.e1–822.e5
    CrossrefPubMedGoogle Scholar
  • 28 Skillington PD, Mokhles MM, Wilson W. , et al. Inclusion cylinder method for aortic valve replacement utilising the Ross operation in adults with predominant aortic stenosis - 99% freedom from re-operation on the aortic valve at 15 years. Glob Cardiol Sci Pract 2013; 2013 (04) 383-394
    PubMedGoogle Scholar
  • 29 Nordmeyer J, Lurz P, Tsang VT. , et al. Effective transcatheter valve implantation after pulmonary homograft failure: a new perspective on the Ross operation. J Thorac Cardiovasc Surg 2009; 138 (01) 84-88
    CrossrefPubMedGoogle Scholar
  • 30 Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16-year experience. J Thorac Cardiovasc Surg 2008; 136 (03) 623-630 , 630.e1–630.e5
    CrossrefPubMedGoogle Scholar