Long-Term Clinical and Imaging Follow-Up After Reinforced Pulmonary Autograft Ross Procedure

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.

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Ross procedure and aortic valve repair: long-term echocardiographic outcomes, quality of life and physical activity of different aortic valve surgery procedures

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.409 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

F Bianco ◽

M Colaneri ◽

V Bucciarelli ◽

FC Surace ◽

FC Iezzi ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Aortic Valve ◽

Aortic Surgery ◽

Ross Procedure ◽

Valve Repair ◽

Sf 36

Abstract Funding Acknowledgements Type of funding sources: None. Background To compare long-term outcomes of aortic valve repair (AVr) and pulmonary autograft replacement (Ross procedure) in terms of echocardiographic parameters, quality of life (QoL), physical activity (PA). Methods In 2005-19, 129 patients (median age 22 [13, 33 IQR], 75% males) underwent aortic surgery in our Department: 40 were Ross (22 years [19, 51 IQR]), 67 AVr (17 years [1, 50 IQR]) and 22 aortic valve replacements (52 years [30, 80 IQR]). We focused on Ross and AVr. Retrospectively, relevant data were collected from medical records and phone re-calls. Physical activity (spontaneous and active) and QoL were assessed utilizing the IPAQ and SF-36 questionnaires. All patients underwent echocardiography pre/post-surgery and the follow-up lasted 12 ± 4 years. Results At the baseline, Ross patients had more aortic stenosis than insufficiency (P = 0.045). At the follow-up, Ross procedures presented more right-ventricle and aortic annulus dilatation (P = 0.002 and P = 0.030, respectively), but higher left-ventricular global longitudinal strain (LV GLS: 18 ± 3.2 % vs. 16 ± 3.3, P = 0.0027). Conversely, AVr experienced more re-do operations (Log-rank P = 0.005). Ross reported better QoL (SF-36: 0.8 ± 0.07 vs. 19 ± 0.4, P-0.045) and were also more active in daily PA (IPAQ ≥ 2500 Mets: 63.8% vs. 6%; P = 0.006). Ross patients practiced more sports activities than AVr (P = 0.011). Conclusions In a relatively small cohort of young and adults post aortic surgery patients, Ross procedures had better prognosis in terms of re-do operations; presented better ventricular function, as assessed by LV GLS. Ross patients had better long-term QoL and showed more spontaneous PA and involvement in sports activity.

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Factors impacting long-term pulmonary autograft durability after the Ross procedure

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.05.046 ◽

2019 ◽

Vol 157 (1) ◽

pp. 134-141.e3 ◽

Cited By ~ 4

Author(s):

Ravil Sharifulin ◽

Alexander Bogachev-Prokophiev ◽

Sergey Zheleznev ◽

Igor Demin ◽

Alexey Pivkin ◽

...

Keyword(s):

Ross Procedure ◽

Pulmonary Autograft

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Neo-aortic Root Dilatation, Aortic Stiffness, and Ventricular interactions in Long-Term Follow-Up After the Ross Procedure in Childhood

Pediatric Cardiology ◽

10.1007/s00246-020-02360-9 ◽

2020 ◽

Vol 41 (6) ◽

pp. 1107-1114

Author(s):

Mehul D. Patel ◽

Adam L. Dorfman ◽

Sunkyung Yu ◽

Ray Lowery ◽

Maryam Ghadimi Mahani ◽

...

Keyword(s):

Aortic Root ◽

Aortic Stiffness ◽

Ross Procedure ◽

Long Term Follow Up ◽

Aortic Root Dilatation ◽

Ventricular Interactions

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Pulmonary homograft stenosis in the Ross procedure: Incidence, clinical impact and predictors in long-term follow-up

Archives of Cardiovascular Diseases ◽

10.1016/j.acvd.2016.09.008 ◽

2017 ◽

Vol 110 (4) ◽

pp. 214-222 ◽

Cited By ~ 3

Author(s):

Laura Pardo González ◽

Martin Ruiz Ortiz ◽

Mónica Delgado ◽

Dolores Mesa ◽

Rafael Villalba ◽

...

Keyword(s):

Clinical Impact ◽

Ross Procedure ◽

Long Term Follow Up ◽

Pulmonary Homograft

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Long-term follow-up of supra-annular pulmonary autograft aortic root replacement in patients with bicuspid aortic valve☆

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.05.056 ◽

2008 ◽

Vol 34 (3) ◽

pp. 583-588 ◽

Cited By ~ 5

Author(s):

Feyzan Özaslan ◽

Thomas Wittlinger ◽

Nadejna Monsefi ◽

Tamimount Bouhmidi ◽

Sinthu Theres ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Aortic Root Replacement ◽

Pulmonary Autograft ◽

Long Term Follow Up

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1158 Autograft degeneration, clinical outcomes and predictors after 21 years follow up in Ross procedure. A single center experience

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.662 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Pericet Rodriguez ◽

L Pardo Gonzalez ◽

A Fernandez Ruiz ◽

R Gonzalez Manzanares ◽

M Ruiz Ortiz ◽

...

Keyword(s):

Learning Curve ◽

Valvular Disease ◽

Ross Procedure ◽

Aortic Lesion ◽

Probability Of Survival ◽

Single Center Experience ◽

Echocardiographic Evaluation ◽

Long Term Follow Up

Abstract Background Autograft regurgitation and the need of autograft reintervention are possible complications of Ross procedure. Purpose Our Aim was to identify rates of autograft degeneration, reintervention and predictive factors valvular disease in a prospective series of a reference cardiovascular surgery hospital. Methods Since November 1997 to July 2009, a total of 107 patients diagnosed of aortic valvular disease requiring surgical treatment underwent Ross surgery (mean age 30 ± 11 years, 69% male, 21 patients <18 years). In all of them, a comprehensive clinical and echocardiographic evaluation was performed before the intervention and at discharge, at 6, 12 months and annually after surgery. Results At the end of follow-up (21 years, median: 17 years, interquartile rank 12-19 years), echocardiographic and clinical data were available in 95 (89%) and 105 (98%) patients, respectively. 30 patients (32%) developed at least moderate aortic regurgitation and 18 of them (17%) required autograft reintervention. Probability of survival free from at least moderate autograft regurgitation and reintervention at the end of follow up was 71% and 83% respectively. Two patients died because of reintervention related complications. A larger native pulmonary annulus size was the only factor, associated to autograft reintervention (HR 1.24 95% [CI] 1.04-1.48, p = 0.01) and at least moderate autograft regurgitation (HR 1.19 95% [CI] 1.03-1.37, p = 0.02). Autograft reintervention was also associated to intervention in the learning curve period (first 12 cases, HR 3.78, [CI] 95% 1.42-10.08, p = 0.008). We found no significant association of these outcomes with previous cardiac surgery, age, sex, aetiology of aortic lesion or native aortic annulus diameter. Conclusion At long term follow-up after Ross procedure, 32% of patients developed at least moderate autograft regurgitation and 17% required autograft reintervention. A larger size of the native pulmonary annulus and intervention in the learning curve period were associated with the need of autograft surgery in the long term follow up.

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Is the Ross procedure as good as we thought it would be?

Cardiology in the Young ◽

10.1017/s1047951106001053 ◽

2006 ◽

Vol 16 (S3) ◽

pp. 125-130 ◽

Cited By ~ 2

Author(s):

Bradley S. Marino ◽

Sara Pasquali ◽

Thomas L. Spray ◽

Gil Wernovsky

Keyword(s):

Aortic Valve ◽

Progressive Disease ◽

Ross Procedure ◽

Surgical Interventions ◽

Pulmonary Autograft ◽

Bovine Xenograft

For patients requiring intervention because of progressive disease of the aortic valve, the perfect palliation will provide a valve that produces normal dynamics of flow, will not require anti-coagulation, will grow with the patient, and have long term durability. Current surgical interventions include aortic valvoplasty, or replacement with either a mechanical or tissue prosthesis. Options for tissue valves include insertion of a pulmonary autograft in the Ross procedure, a cadaveric homograft, or porcine or bovine xenograft valves. The optimal option is still debated.

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Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years

Revista Portuguesa de Cardiologia ◽

10.1016/j.repc.2018.06.014 ◽

2019 ◽

Vol 38 (5) ◽

pp. 315-321 ◽

Cited By ~ 2

Author(s):

Sara Guerreiro ◽

Márcio Madeira ◽

Regina Ribeiras ◽

João Queiroz e Melo ◽

Manuel Canada ◽

...

Keyword(s):

Ross Procedure

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