Serial echocardiographic measurements of the pulmonary autograft in the aortic valve position after the ross operation in a pediatric population using normal pulmonary artery dimensions as the reference standard

The Ross operation is the operation of choice for children and young adults who require aortic valve replacement. Although the allograft does not require anticoagulation and has a superior hemodynamic profile compared to other valve substitutes, concerns regarding allograft and autograft longevity have risen in the last decade. We present a case illustrating an alternative operative technique for patients with failed Ross procedure in which the autograft is recycled in order to avoid a two-allograft replacement.

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The Pulmonary Autograft (Ross Operation) for Aortic Valve Endocarditis

Operative Techniques in Cardiac and Thoracic Surgery ◽

10.1016/s1085-5637(07)70069-4 ◽

1997 ◽

Vol 2 (4) ◽

pp. 302-317

Author(s):

Gösla Pellersson ◽

Frederic Joyce ◽

Jens Tingleff

Keyword(s):

Aortic Valve ◽

Ross Operation ◽

Pulmonary Autograft

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Five-year outcomes of the modified Ross surgery in adults: experience from one center

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-43-50 ◽

2021 ◽

Vol 25 (3) ◽

pp. 43

Author(s):

I. I. Chernov ◽

S. T. Enginoev ◽

D. A. Kondratyev ◽

D. Yu. Kozmin ◽

V. V. Demetskaya ◽

...

Keyword(s):

Overall Survival ◽

Aortic Valve ◽

Hospital Mortality ◽

Pacemaker Implantation ◽

Long Term Results ◽

Aortic Dilatation ◽

Ross Operation ◽

Severe Aortic Regurgitation ◽

Pulmonary Autograft ◽

Valve Pathology

Background. The Ross operation was first proposed in 1967 by D. Ross, and numerous studies have shown that it has excellent long-term results. However, in some patients, it can lead to late dilatation of the pulmonary autograft, which in turn can contribute to repeat operations. To avoid this complication, technical modifications of the Ross operation have been proposed. Aim. To evaluate the immediate and five-year outcomes of the modified Ross surgery in adults. Methods. This retrospective study included patients aged 18 years and older with aortic valve lesions who underwent a modified Ross procedure by one surgeon between January 2014 and December 2019. The median follow-up period was 23 (12–68) months. Results. The study included 43 adult patients. The average age of the patients was 40.0 ± 11.7 years, and 33 (76.7%) were men. The main cause of aortic valve dysfunction was severe aortic regurgitation (32 patients, 74.4%). Infective endocarditis was diagnosed as a cause of aortic valve pathology in 13 (30.2%) patients. Bicuspid aortic valve was present in 29 cases (67.4%). In two cases (4.7%), mini-sternotomy (‘T-shape’) was performed. Ten (23.2%) patients underwent combined interventions. The median duration of cardiopulmonary bypass was 143 (129–160) minutes, and duration of aortic cross-clamp was 116 (109–131) minutes. The autologous inclusion technique was used in 22 (51.2%) cases and the Dacron inclusion technique in 21 (48.8%) cases. Outcomes included no in-hospital mortality, acute renal failure requiring haemodialysis in three patients (7%), pacemaker implantation in two (4.7%), resternotomy for bleeding and stroke in one patient (2.3%) and perioperative myocardial injury in two (4.7%). The five-year overall survival, freedom from reoperation and freedom from dilatation of the ascending aorta or pulmonary autograft ≥ 5 cm after the modified Ross operation were 97.4%, 100.0% and 100.0%, respectively. Conclusion. Modified Ross surgery in adults has excellent immediate outcomes with no in-hospital mortality. The five-year overall survival, freedom from reoperation and freedom from aortic dilatation or pulmonary autograft were 97.4%, 100.0% and 100.0%, respectively.Received 15 February 2021. Revised 3 June 2021. Accepted 4 June 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors Conception and study design: I.I. Chernov, S.T. Enginoev, D.A. Kondratyev, D.Yu. Kozmin Data collection and analysis: E.R. Aliev, V.V. Demetskaya, D.A. Kondratyev, D.Yu. Kozmin Statistical analysis: S.T. Enginoev Drafting the article: I.I. Chernov, S.T. Enginoev Critical revision of the article: I.I. Chernov, D.G. Tarasov Final approval of the version to be published: I.I. Chernov, S.T. Enginoev, D.A. Kondratyev, D.Yu. Kozmin, V.V. Demetskaya, E.R. Aliev, D.G. Tarasov

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Results of aortic valve replacement with the pulmonary autograft-A critical appraisal of the Ross operation

Cirugía Cardiovascular ◽

10.1016/s1134-0096(05)70370-3 ◽

2005 ◽

Vol 12 (2) ◽

pp. 123-126

Author(s):

Paul Simon ◽

Marie-Therese Kasimir ◽

Jyotindra Sharma ◽

Marianne Mathia ◽

M. Lzoch ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Critical Appraisal ◽

Ross Operation ◽

Pulmonary Autograft

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Aortic Root Characteristics of Human Pulmonary Autografts

Circulation ◽

10.1161/circ.102.suppl_3.iii-15 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Cited By ~ 2

Author(s):

Gerald S. Carr-White ◽

A. Afoke ◽

E. J. Birks ◽

S. Hughes ◽

A. O’Halloran ◽

...

Keyword(s):

Aortic Valve ◽

Mechanical Behavior ◽

Aortic Root ◽

Elastic Fiber ◽

Aortic Dilatation ◽

Stiffness Modulus ◽

Anatomic Structure ◽

Functional Changes ◽

Ross Operation ◽

Pulmonary Autograft

Background —After pulmonary autograft replacement of the aortic valve and root, the pulmonary artery (PA) wall is subjected to higher pressures. Concern exists that this may lead to structural and functional changes in the implanted autograft and subsequent aortic root dilatation and neoaortic regurgitation. We therefore assessed root dimensions and neoaortic regurgitation, morphological structure, and mechanical behavior in patients who underwent the Ross operation. Methods and Results —Seventy-four patients who were randomized to undergo aortic valve replacement with an aortic homograft or a pulmonary autograft were followed up echocardiographically for up to 4 years and had their aortic root dimensions measured at the level of the annulus, sinuses, and sinotubular junction. In a separate series of 18 patients who underwent pulmonary autograft surgery and 8 normal organ donors, samples from the PA and aorta were analyzed for medial wall thickness, distribution of the staining of collagen and elastin, and elastin fragmentation. Finally, stress-strain curves were obtained from samples of the PA and aorta from 9 patients who underwent pulmonary autograft surgery and from 1 patient in whom a 4-month-old autograft was explanted. No patient in either group had aortic dilatation at any level of >20% or more than mild aortic regurgitation at up to 4 years of follow-up. The aortic media was thicker in both autografts and normal donors ( P <0.01), and there was a trend for the PA media to be thicker in the autograft group. Elastic fiber in all aortas showed little or no variation, whereas in the PA, there was considerable variation in fragmentation. Patients with higher preoperative PA pressures tended to have lower fragmentation scores (χ 2 P <0.01). The lower stiffness modulus, higher stiffness modulus, and maximum tensile strength of the aorta was 34% to 38% higher than that of the PA ( P <0.01); however, the 4-month-old autograft appeared to show adaptation in mechanical behavior. Conclusions —In our series of patients, there was no significant progressive dilatation of the aortic root. We demonstrated differences in the anatomic structure and mechanical behavior of the PA in vitro and highlighted histological and mechanical modes of adaptation.

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Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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