scholarly journals Re-interventions after the Ross procedure: reasons, technical approaches, immediate outcomes

2021 ◽  
Vol 23 (1) ◽  
pp. 101-111
Author(s):  
R. M. Muratov ◽  
M. I. Fedoseykina ◽  
D. A. Titov ◽  
D. V. Britikov ◽  
G. A. Khugaev
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Pulmonary Trunk ◽  
Elastic Fibers ◽  
Lesion Volume ◽  
Ross Procedure ◽  
Mortality And Morbidity ◽  
Technical Errors ◽  
Valve Insufficiency

Re-interventions after pulmonary autograft aortic valve replacement (Ross procedure) may be associated with dysfunction of the neoaortic, neopulmonary, or both operated valves. Late dysfunction, other than infective endocarditis, is associated with underlying conditions, technical errors, and unsuitable pulmonary trunk replacement materials. Re-interventions are technically complex, while tactical approaches have not been definitively formulated. Objective: to analyze re-interventions in patients after Ross procedure, technical approaches and immediate outcomes. Material and methods. Between 2001 and 2019, 14 patients were reoperated upon within 2 days to 21 years after primary Ross procedure. Early prosthetic endocarditis (2) and technical errors (1) were the reasons for early postoperative re-intervention. Neoaortic valve insufficiency (7), including pulmonary valve dysfunction (2), pulmonary valve degeneration (2), pulmonary prosthetic valve endocarditis (1), aortic, pulmonary and mitral valve endocarditis (1) were the reasons for late postoperative re-intervention. Based on the lesion volume, neoaortic valve replacement (3), neoaortic root replacement (6), including pulmonary valve/trunk replacement (8), and pulmonary trunk stenting (2) were performed. Results. In-hospital mortality was 7.1%. One patient died of early endocarditis after primary procedure. The postoperative period for the remaining patients was uneventful. Microscopic examination of the neoaorta revealed fragmentation of elastic fibers and rearrangement of tissue histoarchitectonics. In the pulmonary position, the aortic allograft and stentless xenograft had severe calcification and valve stenosis. Conclusions. Neoaortic valve insufficiency associated with cusp prolapse and neoaortic root dilatation may be the reasons for re-interventions after the Ross procedure. The second reason for re-interventions is valve graft dysfunction in the pulmonary trunk position. Elective reoperations on the neoaortic root and/or lung graft, despite the large volume, can be performed with low mortality and morbidity. Aortic allografts and xenografts for reconstruction of the right ventricular outflow tract (RVOT) is unjustified due to early and more severe dysfunction compared to pulmonary allograft.

Outcome and right ventricle remodelling after valve replacement for pulmonic stenosis

Heart ◽  
2021 ◽  
pp. heartjnl-2021-320121
Author(s):  
Emilie Laflamme ◽  
Rachel M Wald ◽  
S Lucy Roche ◽  
Candice K Silversides ◽  
Sara A Thorne ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Cardiovascular Death ◽  
Older Age ◽  
Supraventricular Arrhythmia ◽  
Systolic Volume

BackgroundComplications and need for reinterventions are frequent in patients with pulmonary valve stenosis (PVS). Pulmonary regurgitation is common, but no data are available on outcome after pulmonary valve replacement (PVR).MethodsWe performed a retrospective analysis of 215 patients with PVS who underwent surgical valvotomy or balloon valvuloplasty. Incidence and predictors of reinterventions and complications were identified. Right ventricle (RV) remodelling after PVR was also assessed.ResultsAfter a median follow-up of 38.6 (30.9–49.4) years, 93% of the patients were asymptomatic. Thirty-nine patients (18%) had at least one PVR. Associated right ventricular outflow tract (RVOT) intervention and the presence of an associated defect were independent predictors of reintervention (OR: 4.1 (95% CI 1.5 to 10.8) and OR: 3.6 (95% CI 1.9 to 6.9), respectively). Cardiovascular death occurred in 2 patients, and 29 patients (14%) had supraventricular arrhythmia. Older age at the time of first intervention and the presence of an associated defect were independent predictors of complications (OR: 1.0 (95% CI 1.0 to 1.1) and OR: 2.1 (95% CI 1.1 to 4.2), respectively). In 16 patients, cardiac magnetic resonance before and after PVR was available. The optimal cut-off values for RV volume normalisation were 193 mL/m2 for RV end-diastolic volume indexed(sensitivity 80%, specificity 64%) and 100 mL/m2 for RV end-systolic volume indexed(sensitivity 80%, specificity 56%).ConclusionsPrevious RVOT intervention, presence of an associated defect and older age at the time of first repair were predictors of outcome. More data are needed to guide timing of PVR, and extrapolation of tetralogy of Fallot guidelines to this population is unlikely to be appropriate.

scholarly journals Tissue Valve Replacement for Severe Calcified Pulmonary Stenosis: First time in BSMMU

2014 ◽  
Vol 9 (1) ◽  
pp. 54-55
Author(s):  
Rezwanul Haque Bulbul ◽  
Omar Sadeque Khan ◽  
Mohammad Samir Azam Sunny ◽  
Swadesh Ranjan Sarker ◽  
Mostafa Nuruzzaman
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Regurgitation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Pulmonary Valve Replacement ◽  
Tissue Valve ◽  
Biventricular Failure ◽  
First Time

Pulmonary valve replacement for pulmonary regurgitation is a common practise. Pulmonary stenosis relief or after release of right ventricular outflow tract obstruction, progressive pulmonary regurgitation leading to biventricular failure is a big problem. If early pulmonary valve replacement done by homograft or tissue valve then we can overcome this problem. In our case report we have done pulmonary valve replacement by Edward life science Tissue valve for calcified pulmonary valve. And our patient showed a good response after valve replacement. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19514 University Heart Journal Vol. 9, No. 1, January 2013; 54-55

Abstract 2866: The Ross-Yacoub Operation For Aneurismal Autograft Roots: A Strategy To Preserve Autologous Pulmonary Valves And Normal Quality Of Life

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Giovanni Battista Luciani ◽  
Francesca Viscardi ◽  
Mara Pilati ◽  
Maria Antonia Prioli ◽  
Giuseppe Faggian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Valve ◽  
Nyha Class ◽  
Root Diameter ◽  
Ross Procedure ◽  
Cross Sectional ◽  
Uncomplicated Pregnancy ◽  
Valve Insufficiency ◽  
Valve Sparing

Background: Prevalence of autograft dilatation late after the Ross procedure is increasing. To define feasibility and outcome of autograft valve-sparing root reoperation, a 14-year clinical experience was reviewed. Methods: One-hundred-twenty-five late survivors after the Ross procedure (7.0±1.9, 0.5–14 years) had cross-sectional clinical and echocardiographic examination. End-points were freedom from autograft dilatation (Ø>4 cm), from root reoperation, from root replacement and functional outcome after valve-sparing reoperation. Results: Autograft dilatation was found in 33 (26%) patients (freedom of 46±12% at 14 years):12 (10%) patients had aortic aneurysm (>5.0 cm). Age at Ross was 22.6±8.8 years, diagnosis was AI in 9, AS in 1, mixed in 2; 10 had bicuspid aortic valve and 3 prior cardiac operations. All, but one (cylinder inclusion), had undergone root technique. Risk factors for root reoperation were younger age (p=0.04), prior operation (p=0.01), root technique (p=0.001). Nine of 12 had reoperation for aneurysm at 7.8±1.8 years after the Ross procedure, 3 are scheduled. During this study, 2 additional patients underwent root reoperation 12.6 years after Ross procedure done abroad. Two patients had root replacement and 9 (82%) remodelling with autograft-valve preservation (7 Yacoub, 2 sinotubular junction/ascending aorta): all survived. Severe AI, but not root diameter, was associated with failure to preserve the valve (p=0.015). Fourteen-year freedom from root reoperation was 80±8% and from full root replacement 96±3%. Up to 6 years (mean 3.1±1.5) after reoperation, all pts are in NYHA class I and medication-free: 8/9 patients have mild AI or less, while 1 required valve replacement 51 months after remodeling. One patient carried out an uncomplicated pregnancy 3 years after Ross-Yacoub operation. Conclusions: Root reoperation with pulmonary valve preservation is feasible in most patients with autograft aneurysm, allowing for maintenance of normal quality of life. Referral of patients with dilated root for surgery prior to onset of severe valve insufficiency increases likelihood of pulmonary valve-sparing. Mid-term functional behaviour of remodelled autograft roots is rewarding, however continued observation is warranted.

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