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

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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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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15 years experience with 615 homograft and autograft aortic valve replacements

The International Journal of Artificial Organs ◽

10.1177/039139888000300312 ◽

1980 ◽

Vol 3 (3) ◽

pp. 168-172 ◽

Cited By ~ 1

Author(s):

W.H. Wain ◽

R. Greco ◽

A. Ignegeri ◽

E. Bodnar ◽

D.N. Ross

Keyword(s):

Aortic Valve ◽

Valve Replacement ◽

Pulmonary Valve ◽

Alternative Methods ◽

Homograft Valve ◽

Long Term Performance ◽

Term Performance

Homograft valve replacement of the diseased aortic valve with a homologous aortic valve inserted in the sub-coronary position was first performed in July 1962 (Ross 1962). The procedure of transferring the patients autologous pulmonary valve to the aortic position has been used since 1967 (Ross 1967). The long term performance of homograft valves has not been regarded as satisfactory in some centres (Cope-land 1977, Anderson & Hancock 1977) whereas others have shown it to be an excellent valve replacement (Barratt-Boyes, 1977, Bodnar et al 1979). The differing experiences may be the results of alternative methods of sterilization, preservation and surgical insertion. This paper presents information on isolated aortic valve replacements with either homograft or autograft valves over a 15 year period.

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Abstract 14744: Native Bicuspid Pulmonary Valve in D-loop Transposition of the Great Arteries: Outcomes of the Neo-aortic Valve Function and Root Dilation After Arterial Switch Operation

Circulation ◽

10.1161/circ.142.suppl_3.14744 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jane Margaret Irwin ◽

Geoffrey Binney ◽

Kimberlee Gauvreau ◽

Sitaram Emani ◽

Elizabeth Blume ◽

...

Keyword(s):

Aortic Valve ◽

Pulmonary Valve ◽

Arterial Switch Operation ◽

Arterial Switch ◽

Switch Operation ◽

Significant Difference ◽

First Occurrence ◽

D Loop

Introduction: Neo-aortic root dilation (ARD) is common after arterial switch operation (ASO) for D-loop transposition of the great arteries (TGA). We sought to compare short and long-term outcomes for bicuspid native pulmonary valve (BNPV) patients to those with normal trileaflet variants (TNPV). Methods: A retrospective cohort of TGA patients undergoing ASO at Boston Children’s Hospital from 1989-2018 was analyzed, matching BNPV patients 1:3 with TNPV patients by year of ASO; those with >mild subpulmonary stenosis or complex TGA were excluded. Categorical and continuous variables were compared using Fisher’s exact and Wilcoxon rank sum tests, respectively. Kaplan-Meier analyses with log-rank test compared groups for time to first reoperation on the neo-aortic valve, first occurrence of ≥moderate neo-aortic regurgitation (AR), and ARD defined as root z-score ≥4. Hazard ratios were estimated based on the Cox proportional hazards model. Results: A total of 83 BNPV patients were matched with 217 TNPV. BNPV patients were more likely to have a VSD (75% vs 44%, p <0.001). Early surgical outcomes including hospital LOS (11 vs 10 days) and 30-day mortality (3.6% vs 2.8%) were similar. During median 10 years follow-up, neo-aortic valve reoperation occurred in 4 BNPV (6%) vs 6 TNPV (3%) patients, with no statistically significant difference in time to reoperation. More BNPV patients had AR at discharge (4.9% vs 0%, p=0.014) and during follow-up (13.4% vs 4.3%, HR 3.9, p=0.004), with shorter time to first occurrence of AR (Figure 1A); this remained significant after adjusting for presence of VSD. Similarly, ARD was more common in BNPV (45% vs 37%, HR 1.64, p=0.02) with shorter time to first occurrence (Figure 1B). Conclusions: While patients with BNPV have similar short-term ASO outcomes, AR and ARD occur more frequently and earlier compared with TNPV patients. Further long-term studies are needed to determine whether this results in greater need for neo-aortic valve reoperation.

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Robotic, totally endoscopic excision of mitral valve papillary fibroelastoma

10.1510/mmcts.2021.045 ◽

2021 ◽

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Tricuspid Valve ◽

Benign Tumor ◽

Pulmonary Valve ◽

Papillary Fibroelastoma ◽

Robotic Assisted ◽

Endoscopic Excision ◽

Rare Benign Tumor ◽

Sixth Decade

Papillary fibroelastoma is a rare, benign tumor that affects males more frequently than females and that tends to be diagnosed during the fifth or sixth decade of life. It tends to arise on cardiac valves, with the aortic valve being the most frequent location followed by the mitral valve, the tricuspid valve, and the pulmonary valve. We present the case of a robotic-assisted, totally endoscopic excision of a mitral valve papillary fibroelastoma.

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Commissural Malalignment as a predictor of coronary artery abnormalities in patients with transposition of great arteries

Journal of Congenital Cardiology ◽

10.1186/s40949-020-00039-7 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Mohamed Al Nasef ◽

Mohammed H. Alghamdi ◽

Maria L. Bello Valls ◽

Ahmed M. Zahrani ◽

Ali AlAkfash ◽

...

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Pulmonary Valve ◽

Transposition Of Great Arteries ◽

Coronary Artery Abnormalities ◽

Semilunar Valves ◽

Abnormal Coronary Artery ◽

Effective Level ◽

A Minor

Abstract Background In patients with transposition of the great arteries (TGA), commissural malalignment (CM) between semilunar valves may be associated with abnormal coronary (CA) pattern. We intend to assess the degree of CM with incidence of unusual CA anatomy. Methods We proposed a ratio to measure the distance of both ends of the anterior facing sinuses of the pulmonary valve from the facing commissure of the aortic valve. We labeled it as D1 and D2 distance. A ratio (C ratio) of the smaller distance (either D1 or D2 whichever is shorter) over the sum of both D1 and D2 was taken (D1 or D2 whichever is shorter / D1 + D2). We related this ratio with the incidence of the unusual CA anatomy in D-TGA patients. Results We had a total of 158 patients. We defined the point beyond which the C-Ratio becomes significantly associated with abnormal coronary artery pattern, this represents the median effective level (EL50). The EL50 of the C-Ratio was found to be equal to 31% (0.31). The prediction revealed that the CA pattern would most probably be usual when there is a minor commissural malalignment (C-Ratio less than the EL50) and most probably be unusual when there is a major malalignment (C-Ratio is greater than the EL50). The sensitivity was 71% and the specificity 88% (p-value < 0.0001). Conclusions The C-Ratio helps to categorize the degree of CM as minor (less than 0.31) or major (more than 0.31). A higher C-Ratio predicts a higher incidence of unusual CA pattern.

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

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-1010224 ◽

1998 ◽

Vol 46 (04) ◽

pp. 192-197 ◽

Cited By ~ 1

Author(s):

C. Botha ◽

J. Rein ◽

J. Böhm ◽

D. Roser ◽

W. Rupp

Keyword(s):

Pulmonary Valve ◽

Ross Operation ◽

Valve Size

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Percutaneous pulmonary and aortic valve insertion in Belgium: Going for conditional reimbursement or waiting for further evidence?

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309990080 ◽

2009 ◽

Vol 25 (03) ◽

pp. 281-289 ◽

Cited By ~ 1

Author(s):

Mattias Neyt ◽

Imgard Vinck ◽

Marc Gewillig ◽

Hans Van Brabandt

Keyword(s):

Aortic Valve ◽

Heart Valves ◽

Pulmonary Valve ◽

Current Evidence ◽

Review Of The Literature ◽

Randomized Controlled ◽

Tract Disease ◽

Surgical Valve Replacement ◽

Percutaneous Pulmonary Valve ◽

Experienced Team

Objectives:The aim of this study was to assess current evidence supporting the use of percutaneous heart valves (PHV) in degenerative aortic valve and congenital pulmonary outflow tract disease, as compared to conservative medical therapy or traditional surgical valve replacement.Methods:A systematic review of the literature on PHV was performed.Results:No randomized controlled trials (RCT) on PHV have been published so far. Only observational data from series and data presented at cardiology meetings are available. Both percutaneous aortic valve (PAV) and percutaneous pulmonary valve (PPV) seem feasible in the hands of an experienced team. Safety, however, seems to be a problem in PAV, as shown by the high 30-day and 6-month mortality rates.Conclusions:Due to safety concerns, PAV reimbursement is not recommended and patients should only be subjected to PAV insertion within the boundaries of an RCT. In contrast, PPV implantation seems to be a safe and promising technology for which reimbursement under strict conditions may be recommended.

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