Long-Term Pulmonary Valve Function After the Ross Procedure

2019 ◽  
Vol 28 ◽  
pp. S87
Author(s):  
T. Fricke ◽  
E. Buratto ◽  
R. Wynne ◽  
M. Larobina ◽  
L. Grigg ◽  
...  
2019 ◽  
Vol 10 (5) ◽  
pp. 624-627
Author(s):  
Jeremy L. Herrmann ◽  
Amanda R. Stram ◽  
John W. Brown

Prosthesis choice for aortic valve replacement (AVR) in children is frequently compromised by unavailability of prostheses in very small sizes, the lack of prosthetic valve growth, and risks associated with long-term anticoagulation. The Ross procedure with pulmonary valve autograft offers several advantages for pediatric and adult patients. We describe our current Ross AVR technique including replacement of the ascending aorta with a prosthetic graft. The procedure shown in the video involves an adult-sized male with a bicuspid aortic valve, mixed aortic stenosis and insufficiency, and a dilated ascending aorta.


2020 ◽  
Vol 109 (4) ◽  
pp. 1127-1131 ◽  
Author(s):  
Tyson A. Fricke ◽  
Peter D. Skillington ◽  
William Y. Shi ◽  
Edward Buratto ◽  
Rochelle Wynne ◽  
...  

2018 ◽  
Vol 55 (5) ◽  
pp. 885-892 ◽  
Author(s):  
Torsten Christ ◽  
Alexandru Claudiu Paun ◽  
Herko Grubitzsch ◽  
Sebastian Holinski ◽  
Volkmar Falk ◽  
...  

2016 ◽  
Vol 65 (08) ◽  
pp. 656-661 ◽  
Author(s):  
Benjamin Claus ◽  
Nadine Woythal ◽  
Simon Dushe ◽  
Volkmar Falk ◽  
Herko Grubitzsch ◽  
...  

Background The Ross procedure is an established method to treat aortic valve disease, offering excellent hemodynamic characteristics, growth potential, low risk of thromboembolism and no need for anticoagulation. Limitation of homograft quality and availability led to the use of different stentless xenografts. Long-term outcome and implications are yet to be addressed. Methods Forty five adult patients (mean age 38.8 ± 9.6 years) with aortic valve stenosis and/or insufficiency, who underwent the Ross procedure between 1995 and 2002 were identified for long-term evaluation. Patients younger than 18 years, with previous heart surgery and endocarditis were excluded. Stentless xenografts were used in 22 cases (Group X) and homografts in 23 cases (Group H). After review of the patients' history, morbidity and mortality were analyzed and risk stratification was performed. Results Between groups, baseline characteristics and operative data did not differ significantly. Total follow-up was 621.0 patient-years and 98.8% complete. Overall freedom from reoperation at 15 years was 68.4 ± 10.6% in group X and 85. ±  7.9% in group H (p = 0.09), respectively. Freedom from aortic valve reoperation at 15 years was comparable (83.9 ± 8.5% in group X and 85.3 ± 7.9% in group H, p = 0.61), whereas freedom from pulmonary valve reoperation at 15 years was significantly lower in group X (78.9 ± 9.4% versus 100%, p = 0.02). Long-term survival at 15 years was 79.7 ± 9.3% in group X and 94.4 ± 5.4% in group H (p = 0.07), respectively. Conclusions Stentless xenografts used as pulmonary valve substitute in the Ross procedure led to lower freedom from pulmonary valve reoperation compared with homografts. Additionally, there was a trend to inferior long-term survival with xenografts. Therefore, homografts should remain the preferred option for pulmonary valve replacement in the Ross procedure.


2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
S. Steinbach ◽  
M.-T. Dieterlen ◽  
T. Noack ◽  
P. Dohmen ◽  
F. Mohr ◽  
...  

2019 ◽  
Vol 3 (sup1) ◽  
pp. 53-53
Author(s):  
Jamie Romeo ◽  
Grigorios Papageorgiou ◽  
Francisco da Costa ◽  
Hans Sievers ◽  
Ad Bogers ◽  
...  

2021 ◽  
Vol 12 (1) ◽  
pp. 116-123
Author(s):  
Giovanni Stellin ◽  
Alvise Guariento ◽  
Vladimiro L. Vida

Several techniques designed to improve long-term results after repair of tetralogy of Fallot are described. We have recently embarked on a program focused on preserving the native pulmonary valve. Here, combined techniques are described in detail, including intraoperative pulmonary valve balloon dilatation, pulmonary valve reconstruction by delamination and resuspension of the leaflets, and pulmonary valve annulus augmentation. As with any other complex congenital heart disease, senior surgeons should select teaching cases, starting from the less severe side of the spectrum.


1980 ◽  
Vol 3 (3) ◽  
pp. 168-172 ◽  
Author(s):  
W.H. Wain ◽  
R. Greco ◽  
A. Ignegeri ◽  
E. Bodnar ◽  
D.N. Ross

Homograft valve replacement of the diseased aortic valve with a homologous aortic valve inserted in the sub-coronary position was first performed in July 1962 (Ross 1962). The procedure of transferring the patients autologous pulmonary valve to the aortic position has been used since 1967 (Ross 1967). The long term performance of homograft valves has not been regarded as satisfactory in some centres (Cope-land 1977, Anderson & Hancock 1977) whereas others have shown it to be an excellent valve replacement (Barratt-Boyes, 1977, Bodnar et al 1979). The differing experiences may be the results of alternative methods of sterilization, preservation and surgical insertion. This paper presents information on isolated aortic valve replacements with either homograft or autograft valves over a 15 year period.


Author(s):  
Simone Ghiselli ◽  
Cristina Carro ◽  
Nicola Uricchio ◽  
Giuseppe Annoni ◽  
Stefano M Marianeschi

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.


Sign in / Sign up

Export Citation Format

Share Document