The modified Ross operation using a Dacron prosthetic vascular jacket does prevent pulmonary autograft dilatation at 4.5-year follow-up

The aim of this study is to analyze the adaptation properties of the pulmonary autograft in four infants who underwent the Ross operation before one year of life. The patients underwent serial echocardiographic assessments of the autograft diameters at short- and long-term follow-up and values were reported as the Z scores for normal aortic and pulmonary diameters. At a median follow-up time of 18.5 years (range: 18.2-19.4 years), all the patients are alive, none requiring autograft reinterventions. This series shows excellent adaptation potential of the “infant pulmonary autograph” in the long-term, during somatic growth of the patient.

Download Full-text

The Pulmonary Autograft After the Ross Operation: Results of 25-Year Follow-Up in a Pediatric Cohort

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.06.027 ◽

2021 ◽

Vol 111 (1) ◽

pp. 159-167 ◽

Cited By ~ 1

Author(s):

Thierry Bové ◽

Nicolas Bradt ◽

Thomas Martens ◽

Daniel De Wolf ◽

Katrien François ◽

...

Keyword(s):

Ross Operation ◽

Pulmonary Autograft ◽

Operation Results

Download Full-text

Combination of pulmonary autograft dissection and infective endocarditis of three heart valves 14 years after the Ross operation.

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2018-19-5-741-748 ◽

2018 ◽

Vol 19 (5) ◽

pp. 741-748

Author(s):

R.M. Muratov ◽

M.N. Sorkomov ◽

D.A. Titov ◽

S.I. Babenko ◽

G.A. Khugaev

Keyword(s):

Infective Endocarditis ◽

Heart Valves ◽

Ross Operation ◽

Pulmonary Autograft

Download Full-text

Modified Ross operation with reinforcement of the pulmonary autograft: Six-year results

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2010.01.032 ◽

2010 ◽

Vol 139 (6) ◽

pp. 1420-1423 ◽

Cited By ~ 35

Author(s):

Francis Juthier ◽

Carlo Banfi ◽

André Vincentelli ◽

Pierre-Vladimir Ennezat ◽

Thierry Le Tourneau ◽

...

Keyword(s):

Ross Operation ◽

Pulmonary Autograft

Download Full-text

Pulmonary Autograft Mitral Valve Replacement (Ross II): Long-Term Follow-Up of a US Center

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118792196 ◽

2018 ◽

Vol 9 (6) ◽

pp. 645-650

Author(s):

David Blitzer ◽

Jeremy L. Herrmann ◽

John W. Brown

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Sudden Cardiac Arrest ◽

Right Heart Failure ◽

Atrioventricular Canal ◽

Pulmonary Autograft ◽

Atrioventricular Canal Defect

Background: Mitral valve replacement (MVR) with a pulmonary autograft (Ross II) may be a useful technique for pediatric and young adult patients who wish to avoid anticoagulation. Our aim was to evaluate the long-term outcomes of the Ross II procedure at our institution. Methods: Patients undergoing the Ross II procedure between June 2002 and April 2008 were included. Preoperative diagnoses included rheumatic disease (n = 5), congenital mitral valve (MV) pathology (partial atrioventricular canal defect [n = 2], complete atrioventricular canal defect [n = 1], Shone's complex [n = 1]), and myocarditis (n = 1). Results: Ten patients (eight females and two males) between 7 months and 46 years were included. Mean age at surgery was 25.2 ± 15.7 years. There were no in-hospital deaths. Mean follow-up was 11.7 ± 5.2 years. There were three late deaths at 11 months, 5 years, and 11 years, respectively. Causes of death included right heart failure, sepsis, and sudden cardiac arrest. Three patients required subsequent mechanical MVR a median of two years after the Ross II procedure (range: 1-4 years). There was no mortality with reoperation. Echocardiographic follow-up demonstrated mean MV gradients ranging from 2.2 to 9.6 mm Hg. Two patients had greater than mild MV regurgitation postoperatively, and all others had minimal mitral regurgitation or less. Two patients developed moderate MV stenosis. Conclusions: The Ross II procedure is an option for select older children and young adults desiring a durable tissue MVR to avoid long-term anticoagulation.

Download Full-text

Autologous Pericardial Valved Conduit for the Ross Operation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300406 ◽

2005 ◽

Vol 13 (4) ◽

pp. 321-324 ◽

Cited By ~ 5

Author(s):

Taweesak Chotivatanapong ◽

Choosak Kasemsarn ◽

Chaiwuth Yosthasurodom ◽

Pradistchai Chaiseri ◽

Vibhan Sungkahapong ◽

...

Keyword(s):

Valve Replacement ◽

Artery Bypass ◽

Pulmonary Regurgitation ◽

Right Ventricular Outflow Tract ◽

Functional Class ◽

Valve Disease ◽

Related Complication ◽

Ross Operation ◽

Valved Conduit

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

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

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2015.04.123 ◽

2015 ◽

Vol 100 (2) ◽

pp. 631-638 ◽

Cited By ~ 9

Author(s):

Roni M. Jacobsen ◽

Michael G. Earing ◽

Garick D. Hill ◽

Michael Barnes ◽

Michael E. Mitchell ◽

...

Keyword(s):

Ross Operation

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

Long-term adaptive versus maladaptive remodelling of the pulmonary autograft after the Ross operation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa019 ◽

2020 ◽

Vol 57 (5) ◽

pp. 977-985

Author(s):

Magdi H Yacoub ◽

Victor Tsang ◽

Padmini Sarathchandra ◽

Hanna Jensen ◽

Sian Hughes ◽

...

Keyword(s):

Electron Microscopy ◽

Structural Changes ◽

Vasa Vasorum ◽

Calcium Deposition ◽

Free Standing ◽

Ross Operation ◽

Pulmonary Autograft ◽

Arteriolar Wall ◽

Aortic Media

Abstract OBJECTIVES Following the Ross operation, the pulmonary autograft undergoes structural changes (remodelling). We sought to determine the extent, nature and possible determinants of long-term remodelling in the different components of the pulmonary autograft. METHODS Ten pulmonary autografts and 12 normal control valves (6 pulmonary and 6 aortic) were examined by conventional histology, immunocytochemistry and electron microscopy. The structural changes were quantified by morphometry. RESULTS The leaflets from free-standing root replacement valves demonstrated thickening to levels comparable to the normal aortic leaflets, largely due to the addition of a thin layer of ‘neointima’ formed of radial elastic fibres, collagen bundles and glycoaminoglycans, on the ventricular aspect of the leaflets. The leaflets of valves from sub-coronary implantation demonstrated a significantly thicker fibroelastic layer on the ventricularis and calcium deposition in the fibrosa. The media of the explanted valves showed increased number of lamellar units to levels comparable to normal aortic roots. Electron microscopy of valves inserted as free-standing roots showed increased organization into continuous layers. However, intralamellar components showed varying degrees of ‘disorganization’ in comparison to those in the normal aortic media. In addition, there was a marked increase in the number of vasa vasorum with thickened arteriolar wall in the outer media and adventitia. CONCLUSIONS Following the Ross operation, in the very long term, all components of the autograft showed varying degrees of remodelling, which was judged to be largely adaptive. Defining the type, determinants and possible functional effects of remodelling could help in understanding and optimizing the results of the Ross operation.

Download Full-text