Short- and Mid-Term Autograft Outcomes Following the Reinforced Ross Operation

Background The Ross operation for aortic valve replacement continues to be a controversial option because of concerns related to late autograft dilation and progressive neo-aortic insufficiency. In 2005, the reinforced Ross procedure was described at our institution to address this problem. We aim to analyze the short and mid-term outcomes following this procedure. Methods This is a retrospective study of patients who underwent the reinforced Ross operation between 2004 and 2019. A comprehensive chart review was performed. Echocardiograms were independently reviewed by an adult congenital cardiologist. The time to reintervention was evaluated with a Kaplan-Meier curve. Analysis was conducted in JMP 15.1 (SAS Inc., Cary, NC). Results Twenty-five patients underwent the reinforced Ross operation. Twenty-three patients (92%) had bicuspid aortic valve and the most common indication for surgery was a combination of aortic insufficiency and stenosis (n = 18, 72%). The mean follow-up was 6.1 ± 5.0 years. All patients were alive at the time of follow-up. Six patients (24%), from early in our experience, required subsequent aortic reintervention. Median time to reintervention was 41.8 months (0-81.5 months). Sixteen (64%) patients had less than moderate aortic insufficiency at last follow-up. Additionally, average aortic root measurements remained unchanged. Conclusions The reinforced Ross technique was initially proposed as a way to mitigate aortic root dilation seen in the traditional Ross procedure. Our experience suggests an associated learning curve with the majority of aortic reinterventions occurring within the first few years following surgery. Continued follow-up is warranted to assess its long-term durability and functionality.

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A 6-year experience of the Ross procedure in children with congenital aortic valve disease

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2020-48-049 ◽

2020 ◽

Vol 48 (4) ◽

pp. 240-245

Author(s):

D. S. Akatov ◽

V. A. Belov ◽

D. E. Khomich ◽

O. N. Bukhareva ◽

A. A. Makarov ◽

...

Keyword(s):

Aortic Valve ◽

Pulmonary Artery ◽

Postoperative Period ◽

Early Postoperative Period ◽

Ross Procedure ◽

Optimal Method ◽

Advantages And Disadvantages ◽

The Mean

Background: The choice of an optimal method for correction of aortic valve stenosis or insufficiency remains the matter of debate. Some clinicians prefer transluminal balloon angioplasty, some would perform an open type commissurotomy, or aortic valve replacement, or to valve leaflets repair with various materials, while others opt for the Ross procedure. Each of these techniques has its advantages and disadvantages both in the early postoperative period and in the long-term.Aim: To assess the results of the Ross procedure, its complications, survival, and probability of reoperations in the long-term.Materials and methods: We retrospectively analyzed the results of 32 Ross procedures performed from the end of 2012 to the beginning of 2019 in children aged from 3 days to 18 years. Eight children were below 1 year of age, including one newborn. A pulmonary autograft was placed into the aortic position in all children. In 31 children, a homograft was placed into the pulmonary artery. In one patient, an aortic autograft was implanted instead of the pulmonary artery valve. The mean patient age was 6.8 years, mean bodyweight 27.7 kg (range, 3.9–74.6 kg).Results: Two patients died in the early postoperative period (mortality 6.25%). We examined 26 patients at the follow-up, with its mean duration of 2.5 years. There were no indications for replacement of the homograft during the follow-up. One patient, in whom we had implanted an aortic autograft into the pulmonary position, required its replacement after 4.5 years. We have no data on death rates in the long-term.Conclusion: The Ross procedure provides satisfactory results in the early and intermediate postoperative period. Continuous follow-up is needed to determine the time points and the proportion of repeated interventions with a pulmonary homograft and aortic valve.

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Aortic root reimplantation procedure: a new milestone in aortic valve-sparing operations

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-2-49-57 ◽

2016 ◽

Vol 20 (2) ◽

pp. 49

Author(s):

A. M. Chernyavskiy ◽

D. S. Khvan ◽

S. A. Alsov ◽

D. A. Sirota ◽

M. M. Lyashenko

Keyword(s):

Aortic Valve ◽

Conflict Of Interest ◽

Aortic Root ◽

Aortic Insufficiency ◽

Ascending Aorta ◽

Long Term Follow Up ◽

Valve Sparing ◽

Reimplantation Procedure

Aim: Emphasis in this study was placed on clinical and functional assessment of a modified "Florida Sleeve" procedure during surgical correction of ascending aorta aneurysms with concomitant aortic insufficiency. Methods: 32 patients with an aneurysm of the ascending aorta and aortic insufficiency underwent a modified "Florida Sleeve" procedure. The average follow-up was 17 (0-60) months. The average age of patients was 57±13 (23-73) years 56±13 years. Results: The expected 4-year cumulative survival rate was 84.3%. Overall freedom from aortic insufficiency in the late period was 88.9%. Median aortic regurgitation was 1+ (1; 2). Long-term follow-up revealed no valve-associated complications. Conclusion: The aortic root reimplantation procedure enables optimal correction of the existing lesions of the aortic root without performing aortic valve replacement and demonstrates stable clinical and functional outcomes in the long-term period.Key words: aortic aneurysm; aortic valve; valve-sparing operations.FundingThe study had no sponsorship.Conflict of interestThe authors declare no conflict of interest.

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Abstract 4281: Does Preoperative Aortic Insufficiency Affect Outcome Following Aortic Valve Sparing Surgery?

Circulation ◽

10.1161/circ.118.suppl_18.s_857-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Laurent de Kerchove ◽

Munir Boodhwani ◽

David Glineur ◽

Philippe Noirhomme ◽

Gebrine El Khoury

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Systematic Approach ◽

Cox Regression ◽

Aortic Insufficiency ◽

Rank Test ◽

Term Outcome ◽

Kaplan Meier ◽

Valve Sparing

Aortic valve (AV) sparing surgery is an attractive option for the treatment of aortic root pathology. However, presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been associated with poorer outcome. We analyze the influence of preoperative AI severity and the need for cusp repair on the early and mid-term outcomes of AV sparing surgery. From 1996 to 2007, 134 consecutive patients underwent elective AV sparing surgery. (mean age − 52±16 years; 84% male). Significant preoperative AI (3+ or 4+) was present in 83 patients (62%) and 46 (34%) had a bicuspid valve. Root repair was performed with either the reimplantation (67%) or remodeling technique (33%). A systematic approach was used for intraoperative valve assessment and cusp repair was performed in 74 patients (55%). Clinical and echocardiographic follow-up was complete in 100% and 96% respectively at a mean follow-up time of 57 months (range: 12–147 months). Kaplan-Meier curves, log rank test, and Cox regression analyses were used. Hospital mortality was 0.7%. AV cusp repair was required in 53% of patients without significant AI and in 57% with significant AI (p=0.9). Cusp repair was required more frequently in bicuspid versus tricuspid valves (89% vs. 38%, p = 0.005). Overall survival at 5 and 8 years was 94±5% and 86±10% respectively. Freedom from recurrent AI (>2+) was similar with or without significant preoperative AI (90±10% vs. 86±10% at 5 years, p=0.5) and with or without cusp repair (87±11% vs. 89±10%, p=0.6; Figure 1). Freedom from AV reoperation at 5 years was similar with or without significant preoperative AI (94±6% vs. 89±8%, p=0.5) and with and without cusp repair (90±9% vs. 91±8%, p=0.8). With a systematic approach to valve assessment and cusp repair, AV sparing surgery for aortic root pathology has an acceptable early and mid-term outcome, irrespective of preoperative AI or need for cusp repair. Cusp repair is not predicted by presence of preoperative AI but is more frequent in bicuspid valves. Preoperative AI should not be considered a contra-indication for valve sparing surgery.

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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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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.

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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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4069From first in man transcatheter aortic valve implantation, a 15-year experience

European Heart Journal ◽

10.1093/eurheartj/ehz745.0093 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Avinee ◽

E Durand ◽

T Levesque ◽

P Y Litzler ◽

J N Dacher ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Transcatheter Aortic Valve ◽

Kaplan Meier ◽

Transcatheter Heart Valve ◽

Structural Valve Deterioration ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Since the first-in-man transcatheter aortic valve implantation (TAVI) performed in 2002, the number of procedures has dramatically increased. However, long-term data regarding outcome and valve durability remain poor. Purpose We aimed to evaluate the evolution of 30-day outcomes over years and long-term mortality and valve durability after TAVI. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability according to the European standardized definition of structural valve deterioration. Results Between 2002 and 2018, 1530 consecutive patients underwent TAVI including 1285 (84.0%) patients via a femoral approach. A balloon-expandable transcatheter heart valve was predominantly used (1421 patients; 92.9%). The annual transfemoral approach rate increased progressively to reach 93.3%. Age of patients remained stable over time with a global mean age of 83.7±6.5 years old. Logistic EuroSCORE decreased from 49.2±8.2% to 14.3±8.6% (p<0.0001). Thirty-day mortality dramatically decreased below 3% since 2015 and was 0% in 2018. Similarly, major vascular complications decreased from 50.0% in the first year to less than 1% since 2017 (p=0.001). The length of hospital-stay progressively shortened up to a median of 2 days in 2018. The Kaplan-Meier survival estimation was 82.3%, 60.3%, 33.0%; 11.7% and 8.9% respectively at 1, 3, 5, 8 and 10 years. On long-term follow-up the mean aortic gradient remained unchanged (Figure), and only five patients presented a severe prosthetic valve deterioration. Among them, four patients successfully benefited from a valve in valve TAVI procedure. The competing risk analysis at 10 years estimates risk for severe and moderate-or-severe valve deterioration of 1.9±0.9% and 4.3±1.3% respectively. TEE mean transaortic gradient Conclusions Long-term (up to 10 years) follow-up of our large pioneer series of patients treated by TAVI shows a dramatic improvement of outcomes and no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis. Further studies are warranted to study valve durability after TAVI before extension to lower risk patients.

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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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Aortic Valve Intervention During Aortic Root Surgery in Children: A Systematic Review

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120926979 ◽

2020 ◽

Vol 11 (5) ◽

pp. 611-618

Author(s):

Maria Rodriguez ◽

Anahita Malvea ◽

Dayre McNally ◽

Vid Bijelic ◽

Ming Guo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Small Sample Size ◽

Case Series ◽

Small Sample ◽

Aortic Root Surgery ◽

Valve Sparing ◽

One Year

Background: Pediatric aortic root dilatation is a life-threatening condition that lacks guidelines for surgical management. We aimed to analyze the data on aortic valve interventions during root surgery to guide decision-making. Methods: A search was performed of MEDLINE, Embase, CENTRAL, ClinicalTrials.gov , and WHO ICTRP. Citations were screened in duplicate and independently to identify randomized controlled trials, cohorts, and case series involving populations aged 0 to 18 years, who received valve-sparing and valve-replacing aortic root surgeries between 1999 and 2019. Outcomes considered included mortality (perioperative, one year, five year), reintervention rates. Results: After duplicate removal, 689 citations were screened through abstract and full text review, identifying five eligible studies. All five were observational studies evaluating valve-sparing procedures. There were 81 patients with a mean study age range of 9.9 to 13.9 years. Both reimplantation (74%) and remodeling (26%) subtypes were done. Range of mean duration of follow-up was 1.2 to 4.4 years. There was no mortality reported until the one-year follow-up period. The long-term mortality rate was calculated as 0.02 per patient-year (95% CI: 0.01-0.05). The long-term reintervention rate was 0.08 per patient-year (95% CI: 0.05-0.13). Conclusions: There is limited experience on aortic valve intervention during aortic root surgery in children. Single-arm studies on valve-sparing surgeries show excellent survival up to one year. Mortality and reintervention rates increase in the longer term. The small sample size and lack of controlled studies do not allow for direct comparisons between procedure types.

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Transscleral vs Endoscopic Cyclophotocoagulation: Safety and Efficacy When Combined with Phacoemulsification

10.21203/rs.3.rs-1041444/v1 ◽

2021 ◽

Author(s):

Abraham Nirappel ◽

Emma Klug ◽

Cameron Neeson ◽

Mari Chachanidze ◽

Nathan Hall ◽

...

Keyword(s):

Outcome Measures ◽

Open Angle Glaucoma ◽

Common Type ◽

Complication Rates ◽

Kaplan Meier ◽

Surgical Failure ◽

Transscleral Cyclophotocoagulation ◽

The Mean

Abstract Precis: Phacoemulsification combined with MicroPulse transscleral cyclophotocoagulation appears to provide significantly greater long-term IOP reduction than phacoemulsification combined with endoscopic cyclophotocoagulation without compromising safety.Purpose: To compare the effectiveness and safety of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco/ECP), phacoemulsification combined with MicroPulse transscleral cyclophotocoagulation (phaco/MP-TSCPC), and phacoemulsification alone (phaco) in the treatment of coexisting cataract and glaucoma. Methods: Retrospective cohort study of consecutive cases at Massachusetts Eye & Ear. The main outcome measures were the cumulative probabilities of failure between the phaco/ECP group, phaco/MP-TSCPC group, and the phaco alone group with failure defined as reaching NLP vision at any point postoperatively or the inability to maintain ≥20% IOP reduction from baseline with IOP between 5-18 mmHg. Additional outcome measures included changes in average IOP, number of glaucoma medications, and complication rates. Results: 64 eyes from 64 patients (25 phaco/ ECP, 20 phaco/ MPTSCPC, 19 phaco alone) were included in this study. The groups did not differ in age (mean 71.04 ± 6.7 years) or length of follow-up time. Primary open-angle glaucoma was the most common type of glaucoma in the phaco alone (42%) and phaco/ECP (48%) groups while mixed-mechanism glaucoma was the most common type in the phaco/MP-TSCPC group (40%). The mean IOP reductions at 1 year were 3.07 ± 5.3 mmHg from a baseline of 15.78 ± 4.7 in the phaco/ECP group, 6.0 ± 4.3 mmHg from a baseline of 18.37 ± 4.6 in the phaco/MP-TSCPC group and 1.0 ± 1.6 from a baseline of 14.30 ± 4.2 mmHg in the phaco alone group. Surgical failure was less likely in eyes in the phaco/MP-TSCPC and phaco/ECP groups compared to phaco alone based on the Kaplan-Meier survival criteria, with failure defined as the inability to maintain an IOP reduction of 20% or more with IOP between 5-18 mm Hg long term. There were no differences in complications among the three groups. Conclusions: Phaco/MP-TSCPC appears to provide for greater long-term IOP control than phaco alone and phaco/ECP. All three procedures had similar safety profiles.

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