The Externally Supported Ross Operation: Early Outcomes and Intermediate Follow-Up

The feasibility and function of autologous pericardial valved conduit for right ventricular outflow tract reconstruction in the Ross operation were assessed. Between June 1997 and April 2002, 31 patients underwent this procedure at our institution; one was lost to follow-up. The other 26 males and 4 females were aged 17 to 60 years (mean, 36.6 years). Causes of aortic valve disease were infective endocarditis in 26 and rheumatic valve disease in 4. Mean follow-up was 16.7 months (range, 1–58 months). Preoperatively, 9 patients were in functional class II, 19 in class III, and 2 in class IV. Concomitant procedures included coronary artery bypass (1), mitral valve replacement (6), tricuspid valve replacement (1), and ventricular septal defect closure (1). Mean aortic crossclamp time was 199.4 min. There were 4 (13.3%) hospital deaths and no late death. Mean postoperative functional class was 1.17 with +0.36 aortic regurgitation, a peak gradient of 21.9 mm Hg (range, 6–59 mm Hg) across the conduit, and grade +0.96 pulmonary regurgitation. No conduit-related complication was detected. Use of autologous valved conduit for the Ross operation is feasible. Long-term follow-up is mandatory to assess durability.

Download Full-text

Abstract 4784: The Ross Operation: Lessons From Long Term Follow-up

Circulation ◽

10.1161/circ.118.suppl_18.s_943-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Laurent de Kerchove ◽

Jean Rubay ◽

Agnès Pasquet ◽

Alain Poncelet ◽

Munir Boodhwani ◽

...

Keyword(s):

Valve Replacement ◽

Bleeding Event ◽

Right Ventricular Outflow Tract ◽

Aortic Insufficiency ◽

Bleeding Events ◽

Ross Operation ◽

Increased Risk ◽

Long Term Follow Up

Background: The Ross operation is considered the procedure of choice for aortic valve replacement in children and represents an attractive alternative in selected young adults. However, long term follow-up has demonstrated high rates of pulmonary autograft failure raising concern regarding its clinical utility. We analyze long term outcomes of our Ross series, focusing on predictors of autograft failure. Methods: Between 1991 and 2006, 260 consecutive patients underwent Ross operation. Mean age was 35±15 years (range: 1 day to 64 years) and 75% were male. The technique for autograft implantation was a full root replacement in 70% (n=183), inclusion cylinder in 28% (n=73) and subcoronary in 2% (n=4). Right ventricular outflow tract (RVOT) was reconstructed with a pulmonary homograft in 94% (n=245) and with a xenograft in 6% (n=15). Mean clinical follow-up (97% complete) was 97±46 months (13 to 196 months). Echocardiographic follow-up was available in 234 survivors (94%). Results: Hospital mortality was 1.9% (n=5) and 7 patients died during follow-up (3 non cardiac). Twelve year overall survival was 93±4% and freedom from autograft reoperation and from autograft valve replacement was 83±7% and 94±5% respectively. Twenty-five patients (9.6%) underwent autograft reoperation either for insufficiency (n=8), autograft or ascending aorta dilatation (n=6), or both (n=11) with no mortality. In 76% (n=19) of these patients, the autograft valve was preserved. Predictors for autograft dilatation (≥45 mm) were preoperative aortic insufficiency and full root technique. RVOT reintervention was required in 10 (4%) patients (reoperations n=7, balloon dilatation n=3). Twelve year freedom from RVOT reintervention was 95±4. Twelve year freedom from thrombo-embolic and bleeding events was 99±1% (1 stroke, 1 TIA, 1 bleeding event). Conclusions: This long terms study confirms the excellent survival after Ross operation with an extremely low rate of thrombo-embolic and bleeding events. Autograft reoperation rate remains acceptable. Full root technique is associated with increased risk of autograft dilatation, and should be avoided especially in adults with preoperative aortic insufficiency. Autograft valve preservation is feasible in autograft reoperation.

Download Full-text

Midterm Echocardiographic Follow-Up After Ross Operation. Briand M, Pirabot P, Dumesnil JG, Cartier P. Circulation 2000;103 (Suppl III):III-10–14

ACC Current Journal Review ◽

10.1016/s1062-1458(01)00197-0 ◽

2001 ◽

Vol 10 (2) ◽

pp. 72-73

Keyword(s):

Ross Operation

Download Full-text

The Switch Back Ross Operation: Report of Two Cases With Good Medium-to-Long-Term Follow-Up

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135111428161 ◽

2012 ◽

Vol 3 (2) ◽

pp. 244-248 ◽

Cited By ~ 4

Author(s):

Walter Vicente ◽

Cesar Augusto Ferreira ◽

Jyrson Guilherme Klamt ◽

Paulo Henrique Manso ◽

Oswaldo Cesar Almeida Filho ◽

...

Keyword(s):

Arterial Switch Operation ◽

Valve Surgery ◽

Valve Regurgitation ◽

Ross Operation ◽

Switch Operation ◽

Long Term Follow Up ◽

Good Medium ◽

The Ideal

Submitted July 20, 2011; Accepted October 6, 2011. Neoaortic root dilatation and neoaortic valve regurgitation following the arterial switch operation for transposition of the great arteries may ultimately require neoaortic root and/or neoaortic valve surgery. The ideal surgical approach to these lesions remains debatable. Hazekamp et al, in 1997, introduced the replacement of the neoaortic root by the neopulmonary autograft and named this procedure the switch back Ross operation. We report two patients who were successfully treated at our institution with the switch back Ross operation, with good results at, respectively, four- and five-year follow-up.

Download Full-text

Mechanism of autograft insufficiency after the Ross operation in children

Cardiology in the Young ◽

10.1017/s1047951112001783 ◽

2012 ◽

Vol 23 (4) ◽

pp. 523-529 ◽

Cited By ~ 1

Author(s):

Motohiko Goda ◽

Marc Gewillig ◽

Benedicte Eyskens ◽

Ruth Heying ◽

Bjorn Cools ◽

...

Keyword(s):

Aortic Root ◽

Time Course ◽

Body Measurements ◽

Age Group ◽

Z Score ◽

Root Reinforcement ◽

Ross Operation ◽

Relationship Of ◽

The Relationship

AbstractBackgroundIt is unclear how autografts grow and dilate after the Ross operation in children. We analysed autograft growth and dilatation in children who underwent the Ross operation and examined the relationship of these factors to autograft failure.MethodsFrom our institutional database, we retrospectively identified 33 children who underwent the Ross operation without aortic root reinforcement (mean age 9.9 years) and had normal body measurements and echocardiographic data throughout follow-up.ResultsAutograft insufficiency developed in 10 patients 5.1 years after the Ross operation. The average Z score at the development of autograft insufficiency was −0.1 (range from −2.0 to 6.1). The proportions of patients who remained free of autograft insufficiency at 5 and 10 years were 87.2% and 55.7%, respectively. A consistent trend in the time course of Z score was not found in any age group studied.ConclusionsAutograft growth and dilation after the Ross operation varied widely among patients, and the incidence of autograft insufficiency was independent of annulus size.

Download Full-text

Abstract 16230: Pulmonary Autograft Wall Stresses One Year After Ross Operation

Circulation ◽

10.1161/circ.142.suppl_3.16230 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Edgardo Alonso ◽

Yue XUAN ◽

Alexander Emmott ◽

Zhongjie Wang ◽

Shalni Kumar ◽

...

Keyword(s):

Ascending Aorta ◽

Patient Specific ◽

Principal Stresses ◽

Ross Operation ◽

Children And Young Adults ◽

Specific Material ◽

One Year ◽

Patients Experience

Introduction: The Ross procedure is an excellent option for children and young adults who need aortic valve replacement as this surgery can restore patient survival to that of a normal sex and aged-matched population. However, some patients experience aneurysmal formation during autograft remodeling and require reoperation. As the underlying biomechanics of autograft remodeling are unknown, we investigated patient-specific wall stresses in pulmonary autografts one year post-operatively to better understand systemic pressure-driven early autograft wall stresses. Methods: Ross patients (n=16) who underwent intraoperative collection of pulmonary root/aortic specimen, and subsequent one-year MRI follow-up were recruited. Patient-specific material properties from their tissue were experimentally determined and incorporated into autograft ± Dacron and ascending aorta finite element models. A multiplicative approach was used to account for pre-stress geometry from in-vivo MRI. Physiologic pressure loading was simulated with LS-DYNA software. Results: At systemic systole, first principal stresses were 567kPa (25-75% IQR, 485-675kPa), 809kPa (691-1219kPa), and 382kPa (334-413kPa) at autograft sinuses, sinotubular junction (STJ), and ascending aorta, respectively. Second principal stresses were 355kPa (320-394kPa), 360kPa (310-426kPa), and 184kPa (147-222kPa) at autograft sinuses, STJ, and ascending aorta, respectively. Mean autograft diameters were 38.3±5.3mm, 29.9±2.7mm, and 26.6±4.0mm at sinuses, STJ, and annulus, respectively. Conclusions: First principal stresses were mainly located at STJ, particularly when Dacron reinforcement was applied to constrain STJ dilatation. However, at one-year after the Ross operation, autograft dilatation was not seen despite elevated autograft wall stresses compared to their internal controls, the lower wall stresses in corresponding native distal ascending aorta. In this group of patients, higher risk of dilatation is expected in the sinuses and STJ if not constrained by Dacron than the corresponding ascending aorta. Future follow-up will elucidate the biomechanics of long-term autograft remodeling to develop predictive models for autograft dilatation.

Download Full-text