The Ross Operation: Do Native Aortic, Native Pulmonary, and Homograft Pulmonary Valve Size and Form Differences Influence Results?

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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Abstract 3176: Percutaneous Pulmonary Valve Implantation Is A Successful Treatment Option For RVOT Conduit Failure After Ross Procedure

Circulation ◽

10.1161/circ.116.suppl_16.ii_713-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Johannes Nordmeyer ◽

Philipp Lurz ◽

Louise Coats ◽

Fiona Walker ◽

Andrew M Taylor ◽

...

Keyword(s):

Treatment Option ◽

Pulmonary Valve ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Ross Procedure ◽

Ross Operation ◽

Percutaneous Pulmonary Valve Implantation ◽

Valve Implantation ◽

Percutaneous Pulmonary Valve ◽

Pulmonary Valve Implantation

Background- The Ross operation offers good autograft function and low re-operation rates for the left ventricular outflow tract, however, the rate of conduit dysfunction in the right ventricular outflow tract (RVOT) remains a significant concern. Percutaneous pulmonary valve implantation (PPVI) is a novel trans-catheter treatment option for RVOT conduit dysfunction. Methods and Results- Of the 156 patients who underwent PPVI at our institutions with the current device, we retrospectively analyzed the outcomes of 11 patients (mean age: 26±5 years) who had RVOT conduit failure, 11.3±3.2 years following the Ross operation. PPVI could be performed in all patients (procedure time: 100±15 min; fluoroscopy time: 20±6 min). The RVOT gradient during catheterization and pulmonary regurgitant fraction (PRF) measured on magnetic resonance imaging (MRI) fell after PPVI (RVOT gradient: 35±6.5 mmHg to 14±2.8 mmHg, P<0.01; PRF: 18±6% to 3±2%, P<0.05). During mean follow-up of 17.4±5.2 months, there was 1 explantation (re-stenosis). The probability for freedom from RVOT re-operation was 100% at 1 year and 85.7% at 3 years. Conclusions- Failure of the conduit in the RVOT following Ross procedure can be successfully treated with PPVI to decrease the cumulative surgical burden in the lifetime management of congenital or acquired lesions of ventricular outflow tracts.

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Late fulminant pulmonary valve endocarditis after the Ross operation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2009.03.001 ◽

2010 ◽

Vol 139 (5) ◽

pp. e99-e100 ◽

Cited By ~ 3

Author(s):

Giovanni Melina ◽

Ismail El-Hamamsy ◽

Riccardo Sinatra ◽

Magdi H. Yacoub

Keyword(s):

Pulmonary Valve ◽

Ross Operation

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The Ross operation: utilization of the patient’s own pulmonary valve as a replacement device for the diseased aortic valve

Expert Review of Cardiovascular Therapy ◽

10.1586/14779072.3.6.1017 ◽

2005 ◽

Vol 3 (6) ◽

pp. 1017-1026 ◽

Cited By ~ 1

Author(s):

Cornelius A Botha

Keyword(s):

Aortic Valve ◽

Pulmonary Valve ◽

Ross Operation ◽

Replacement Device

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Biventricular root replacement for transcatheter pulmonary valve endocarditis after Ross operation: Double the trouble

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.07.111 ◽

2019 ◽

Vol 157 (1) ◽

pp. e5-e7 ◽

Cited By ~ 1

Author(s):

T.K. Susheel Kumar ◽

Kaitlin Balduf ◽

Umar Boston ◽

Christopher Knott-Craig

Keyword(s):

Pulmonary Valve ◽

Ross Operation

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Relationships between the dimensions of the human aortic and pulmonary valve leaflets: implications on Ross' operation

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(96)80372-1 ◽

1996 ◽

Vol 10 (8) ◽

pp. 599-602 ◽

Cited By ~ 2

Author(s):

M SANTIAGO ◽

E DUCLASOARES ◽

M SANTIAGO ◽

J QUEIROZEMELO

Keyword(s):

Pulmonary Valve ◽

Ross Operation

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Bovine jugular vein conduit versus pulmonary homograft in the Ross operation

Cardiology in the Young ◽

10.1017/s1047951119003007 ◽

2019 ◽

Vol 30 (3) ◽

pp. 323-327

Author(s):

Parth M. Patel ◽

Jeremy L. Herrmann ◽

Mark D. Rodefeld ◽

Mark W. Turrentine ◽

John W. Brown

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Pulmonary Valve ◽

Jugular Vein ◽

Interquartile Range ◽

Ross Procedure ◽

Ross Operation ◽

Bovine Jugular Vein ◽

Pulmonary Homograft

AbstractObjectives:The Ross procedure involves using the native pulmonary valve for aortic valve replacement then replacing the pulmonary valve with an allograft or xenograft. We aimed to compare our age-matched experience with the bovine jugular vein conduit and the pulmonary homograft for pulmonary valve replacement during the Ross procedure in children.Methods:Between 1998 and 2016, 15 patients <18 years of age underwent a Ross procedure using the bovine jugular vein conduit (Ross-Bovine Jugular Vein Conduit) at our institution. These patients were age-matched with 15 patients who had the Ross operation with a standard pulmonary homograft for right ventricular outflow tract reconstruction (Ross-Pulmonary Homograft). Paper and electronic medical records were retrospectively reviewed.Results:The median age of the Ross-Bovine Jugular Vein Conduit and Ross-Pulmonary Homograft patients were 4.8 years (interquartile range 1.1–6.6) and 3.3 years (interquartile 1.2–7.6), respectively (p = 0.6). The median follow-up time for the Ross-Bovine Jugular Vein Conduit and Ross-Pulmonary Homograft groups were 1.7 years (interquartile range 0.5–4.9) and 6.8 years (interquartile range 1.9–13.4), respectively (p = 0.03). Overall, 5-year survival, freedom from redo aortic valve replacement, and freedom from pulmonary valve replacement were similar between groups.Conclusion:The bovine jugular vein conduit and pulmonary homograft have favourable mid-term durability when used for right ventricular outflow tract reconstruction for the Ross operation. The bovine jugular vein conduit may be a suitable replacement for appropriately sized patients undergoing a Ross aortic valve replacement, though longer follow-up is needed.

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