scholarly journals Five-year outcomes of the modified Ross surgery in adults: experience from one center

2021 ◽  
Vol 25 (3) ◽  
pp. 43
Author(s):  
I. I. Chernov ◽  
S. T. Enginoev ◽  
D. A. Kondratyev ◽  
D. Yu. Kozmin ◽  
V. V. Demetskaya ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Valve ◽  
Hospital Mortality ◽  
Pacemaker Implantation ◽  
Long Term Results ◽  
Aortic Dilatation ◽  
Ross Operation ◽  
Severe Aortic Regurgitation ◽  
Pulmonary Autograft ◽  
Valve Pathology

<p><strong>Background.</strong> The Ross operation was first proposed in 1967 by D. Ross, and numerous studies have shown that it has excellent long-term results. However, in some patients, it can lead to late dilatation of the pulmonary autograft, which in turn can contribute to repeat operations. To avoid this complication, technical modifications of the Ross operation have been proposed.<br /><strong>Aim.</strong> To evaluate the immediate and five-year outcomes of the modified Ross surgery in adults.<br /><strong>Methods.</strong> This retrospective study included patients aged 18 years and older with aortic valve lesions who underwent a modified Ross procedure by one surgeon between January 2014 and December 2019. The median follow-up period was 23 (12–68) months.<br /><strong>Results.</strong> The study included 43 adult patients. The average age of the patients was 40.0 ± 11.7 years, and 33 (76.7%) were men. The main cause of aortic valve dysfunction was severe aortic regurgitation (32 patients, 74.4%). Infective endocarditis was diagnosed as a cause of aortic valve pathology in 13 (30.2%) patients. Bicuspid aortic valve was present in 29 cases (67.4%). In two cases (4.7%), mini-sternotomy (‘T-shape’) was performed. Ten (23.2%) patients underwent combined interventions. The median duration of cardiopulmonary bypass was 143 (129–160) minutes, and duration of aortic cross-clamp was 116 (109–131) minutes. The autologous inclusion technique was used in 22 (51.2%) cases and the Dacron inclusion technique in 21 (48.8%) cases. Outcomes included no in-hospital mortality, acute renal failure requiring haemodialysis in three patients (7%), pacemaker implantation in two (4.7%), resternotomy for bleeding and stroke in one patient (2.3%) and perioperative myocardial injury in two (4.7%). The five-year overall survival, freedom from reoperation and freedom from dilatation of the ascending aorta or pulmonary autograft ≥ 5 cm after the modified Ross operation were 97.4%, 100.0% and 100.0%, respectively.<br /><strong>Conclusion.</strong> Modified Ross surgery in adults has excellent immediate outcomes with no in-hospital mortality. The five-year overall survival, freedom from reoperation and freedom from aortic dilatation or pulmonary autograft were 97.4%, 100.0% and 100.0%, respectively.</p><p>Received 15 February 2021. Revised 3 June 2021. Accepted 4 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: I.I. Chernov, S.T. Enginoev, D.A. Kondratyev, D.Yu. Kozmin<br />Data collection and analysis: E.R. Aliev, V.V. Demetskaya, D.A. Kondratyev, D.Yu. Kozmin<br />Statistical analysis: S.T. Enginoev<br />Drafting the article: I.I. Chernov, S.T. Enginoev<br />Critical revision of the article: I.I. Chernov, D.G. Tarasov<br />Final approval of the version to be published: I.I. Chernov, S.T. Enginoev, D.A. Kondratyev, D.Yu. Kozmin, V.V. Demetskaya, E.R. Aliev, D.G. Tarasov</p>

scholarly journals Three-year results of Ozaki surgery in patients aged ≥65 years: a multicentre study

2021 ◽  
Vol 25 (4) ◽  
pp. 53
Author(s):  
I. I. Chernov ◽  
S. T. Enginoev ◽  
R. N. Komarov ◽  
D. G. Tarasov ◽  
Yu. S. Sinelnikov ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Valve ◽  
Hospital Mortality ◽  
Multicentre Study ◽  
Conflict Of Interest ◽  
Left Ventricular ◽  
Long Term Results ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Valve Opening

<p><strong>Background.</strong> Currently, aortic valve stenosis is the most common disease of the native valve, which affects 5% of the elderly population. In symptomatic patients, aortic valve replacement is the ‘gold standard’. For patients aged ≥65 years, the use of biological prostheses is recommended. The Ozaki operation is an alternative to bioprostheses.</p><p><strong>Aim.</strong> The aim of this study was to evaluate the immediate and 3-year results of Ozaki surgery in patients aged ≥65 years.</p><p><strong>Methods.</strong> This was a prospective multicentre study conducted on 107 patients aged ≥65 years, who underwent the Ozaki procedure at three centres during 2016–2019. There were 46 (43%) men. The median age of the patients was 69 [67–74] years. Severe aortic stenosis was the major cause of aortic valve dysfunction (106 patients [99.1%]). Chronic heart failure III–IV functional class according to NYHA was diagnosed in 47 (43.9%) patients. The following complications were also registered: atrial fibrillation in 30 (28%) patients, a history of diabetes mellitus in 16 (15%) patients, chronic obstructive pulmonary disease in 14 (13.1%) patients and coronary artery disease in 42 (39.2%) patients. Bicuspid aortic valve was detected in 36 (34.6%) patients. There were 72 (67.2%) patients with a small annulus (≤21 mm) and 59 (55.14%) patients with a left ventricular ejection fraction of 64%. The median follow-up period was 23 [18–33] months. This study included all patients who underwent Ozaki surgery from 2016 to 2019.</p><p><strong>Results.</strong> No patient had any conversions. A total of 45 (42.1%) patients underwent combined interventions. The operation duration was 240 [214–300] min, cardiopulmonary bypass duration was 104 [93–120] min and aortic cross-clamp duration was 82 [72–95] min. The rate of hospital mortality was 1.9%, and the incidence rates of acute renal failure requiring haemodialysis, stroke, pacemaker implantation, sepsis and reoperation for bleeding were 1.9%, 0.9%, 1.9%, 0.9% and 0.9%, respectively. The hospitalisation duration was 14 [11–16] days. The gradients of peak and mean pressure on the aortic valve after surgery were 9 [7–13] and 4 [3–6] mmHg, respectively, and the effective valve opening area was 2.6 [2.3–2.9] cm<sup>2</sup>. None of the patients had moderate and severe aortic regurgitation. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively.</p><p><strong>Conclusion.</strong> The Ozaki operation in patients aged ≥65 years has good immediate results, with a hospital mortality rate of 1.9%, excellent haemodynamic parameters with an average pressure gradient across the aortic valve of 4 [3–6] mmHg and a valve opening area of 2.6 [2.3–2.9] cm<sup>2</sup>. The 3-year overall survival and freedom from reoperation were 88.6% and 97%, respectively. Further monitoring of these patients is required to evaluate long-term results, and there is also a need for randomised clinical trials comparing Ozaki operation with bioprostheses.</p><p>Received 4 February 2021. Revised 21 June 2021. Accepted 23 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Conception and study design: I.I. Chernov, R.N. Komarov, D.G. Tarasov, Yu.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, K.Yu. Zhigalov<br /> Data collection and analysis: B.K. Kadyraliev, A.M. Ismailbaev, B.M. Tlisov, D.A. Zorin, M.I. Tcheglov<br /> Statistical analysis: S.T. Enginoev<br /> Drafting the article: I.I. Chernov, S.T. Enginoev<br /> Critical revision of the article: I.I. Chernov, R.N. Komarov, D.G. Tarasov, Yu.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, K.Yu. Zhigalov<br /> Final approval of the version to be published: I.I. Chernov, S.T. Enginoev, R.N. Komarov, D.G. Tarasov, Y.S. Sinelnikov, A.V. Marchenko, V.B. Arutyunayan, B.K. Kadyraliev, A.M. Ismailbaev, B.M. Tlisov, D.A. Zorin, M.I. Tcheglov, K.Yu. Zhigalov</p>

Aortic Root Characteristics of Human Pulmonary Autografts

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Gerald S. Carr-White ◽  
A. Afoke ◽  
E. J. Birks ◽  
S. Hughes ◽  
A. O’Halloran ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mechanical Behavior ◽  
Aortic Root ◽  
Elastic Fiber ◽  
Aortic Dilatation ◽  
Stiffness Modulus ◽  
Anatomic Structure ◽  
Functional Changes ◽  
Ross Operation ◽  
Pulmonary Autograft

Background —After pulmonary autograft replacement of the aortic valve and root, the pulmonary artery (PA) wall is subjected to higher pressures. Concern exists that this may lead to structural and functional changes in the implanted autograft and subsequent aortic root dilatation and neoaortic regurgitation. We therefore assessed root dimensions and neoaortic regurgitation, morphological structure, and mechanical behavior in patients who underwent the Ross operation. Methods and Results —Seventy-four patients who were randomized to undergo aortic valve replacement with an aortic homograft or a pulmonary autograft were followed up echocardiographically for up to 4 years and had their aortic root dimensions measured at the level of the annulus, sinuses, and sinotubular junction. In a separate series of 18 patients who underwent pulmonary autograft surgery and 8 normal organ donors, samples from the PA and aorta were analyzed for medial wall thickness, distribution of the staining of collagen and elastin, and elastin fragmentation. Finally, stress-strain curves were obtained from samples of the PA and aorta from 9 patients who underwent pulmonary autograft surgery and from 1 patient in whom a 4-month-old autograft was explanted. No patient in either group had aortic dilatation at any level of >20% or more than mild aortic regurgitation at up to 4 years of follow-up. The aortic media was thicker in both autografts and normal donors ( P <0.01), and there was a trend for the PA media to be thicker in the autograft group. Elastic fiber in all aortas showed little or no variation, whereas in the PA, there was considerable variation in fragmentation. Patients with higher preoperative PA pressures tended to have lower fragmentation scores (χ 2 P <0.01). The lower stiffness modulus, higher stiffness modulus, and maximum tensile strength of the aorta was 34% to 38% higher than that of the PA ( P <0.01); however, the 4-month-old autograft appeared to show adaptation in mechanical behavior. Conclusions —In our series of patients, there was no significant progressive dilatation of the aortic root. We demonstrated differences in the anatomic structure and mechanical behavior of the PA in vitro and highlighted histological and mechanical modes of adaptation.

scholarly journals P24: MANAGEMENT OF RHEUMATIC VALVE DISEASE OF THE AORTIC VALVE USING THE OZAKI PROCEDURE WITH AUTOLOGOUS PERICARDIUM

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
A Asif ◽  
M Caputo
Keyword(s):  
Aortic Valve ◽  
Intraoperative Complications ◽  
Valve Disease ◽  
Severe Aortic Regurgitation ◽  
Autologous Pericardium ◽  
End Diastolic Volume ◽  
Rheumatic Valve Disease ◽  
Coronary Cusp ◽  
Valve Pathology ◽  
Diastolic Murmur

Abstract Case-Study A 15-year-old boy was referred to our tertiary centre from his local paediatric services with a background of rheumatic fever, severe aortic regurgitation (AR) and mild to moderate mitral regurgitation. He had a history of angina and dyspnoea on exertion, a 2/6 ejection systolic murmur and 2/4 end diastolic murmur. Transthoracic echocardiography showed severe aortic valve insufficiency (with flow reversal seen in the descending aorta and an LV end diastolic volume of 173 ml/m2) and trivial pulmonary valve regurgitation. Autograft failure following the favoured Ross procedure deemed the patient as a candidate for an Ozaki procedure. Autologous pericardium was used to replace the diseased aortic valve. Intraoperative transoesophageal echocardiography showed a deficient left coronary cusp leaflet and a retracted right coronary cusp leaflet. The patient was under cardiopulmonary bypass for 124 minutes and on cross-clamping for 99 minutes with no intraoperative complications. Histological examination of the aortic valve leaflets showed neovascularisation, myxoid changes and disarray of the fibrous stroma. Postoperative recovery was uneventful. The postoperative echocardiogram showed trivial AR, end diastolic volume 217ml, end systolic volume 12 ml and 40% ejection fraction. There was full resolution of the dyspnoea, angina and diastolic murmur on follow-up 4-months postoperatively as supported by healthy valve function on echocardiography. This case highlights that in those of risk of multiple valve pathology, such as in rheumatic valve disease, an Ozaki procedure using autologous pericardium is a viable surgical option for paediatric aortic valve repair with good outcomes. Take-home message In cases of systemic conditions affecting the heart valves where there is multiple valve pathology and risk of autograft failure, such as rheumatic valve disease, the use of autologous pericardium to replace these valves has shown to be a viable option in this paediatric case.

scholarly journals AB0549 THE RELEVANCE OF AORTIC STENOSIS AND OUTCOME OF TAVI PROCEDURE FOR VALVE REPAIR IN SCLERODERMA PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1571.3-1571
Author(s):  
A. Balbir-Gurman ◽  
Y. Braun-Moscovici
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Significant Coronary Artery Disease ◽  
Heart Catheterization ◽  
Long Term Outcome ◽  
Aortic Valve Implantation ◽  
Valve Pathology ◽  
Valve Implantation

Background:Patients with systemic sclerosis (SSc) are at risk for developing aortic valve changes. The prevalence of aortic valve stenosis (AS) in SSc patients is unknown. Previously, patients with AS were treated with valve replacement; in recent years, Trans Catheter Aortic Valve Implantation (TAVI) is widely used in general population. The safety of Trans Catheter Aortic Valve Implantation (TAVI) in SSc has not been assessed.Objectives:A retrospective study on aortic valve pathology and treatments including TAVI performance.Methods:We reviewed 374 records of SSc patients at our site EUSTAR cohort and extracted cases with reported AS confirmed by ECHO cardiography and heart catheterization.Results:We found data on 13 (3.4%) patients with AS: 12 females (92.3%); mean age 70.3 (SD 7.7) years, disease duration 15.4 (SD 6.3) years. Ten patients had limited SSc (76.9%, all cared anti-centromere antibodies) and 3 diffuse SSc (1 patient had RNAP3 and 2 had anti-topoisomerase antibodies); 5 (38.5%) patients had significant coronary disease (3 underwent CABG, 2 had several PTCA). Eight (61.5%) patients dead during years 2004 - 2019. Aortic valve replacement was performed in 5 patients (4 – metal and 1 – biological); 2 patients did not undergo AS repair due to impaired general condition; 6 patients underwent TAVI between January 2013 and December 2019 (5 at Rambam Cardiology Institute). All SSc patients underwent trans femoral TAVI under conscious sedation. The procedure was successful in all patients. The length of hospitalization was 5-14 days (mean 8.2 days); 3 (50%) patients needed pacemaker implantation (they did not have previous conduction abnormalities). The follow-up duration after TAVI was between 5 and 67 months (mean 20.7). During follow-up one patient developed bacterial endocarditis related to pacemaker device two months after the procedure; the event resolved after removing the device and according antibiotics treatment; the same patient had transient ischemic attack two years later and another pacemaker implantation 3 years later due to complete AV block. One patients dead from urosepsis 11 months after TAVI, the death was not related to procedure. One patient developed anemia due to large hematoma after the procedure.Conclusion:Screening for aortic valve pathology is essential as AS is not rare in SSc patients especially in those with long standing limited disease and positivity to centromere antibodies. AS in SSc patients may be associated with clinically significant coronary artery disease. TAVI was safe in our SSc patients without in-hospital mortality and benign long-term outcome.Disclosure of Interests:Alexandra Balbir-Gurman Consultant of: Novartis, Yolanda Braun-Moscovici: None declared

Recycling of the Pulmonary Autograft During Reverse Ross Operation: From Pulmonary Valve to Neoaortic Valve and Back

2019 ◽  
Vol 10 (2) ◽  
pp. 242-244
Author(s):  
Martin Schmiady ◽  
Dominique Bettex ◽  
Michael Hübler ◽  
Martin Schweiger
Keyword(s):  
Young Adults ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Operative Technique ◽  
Pulmonary Valve ◽  
Ross Procedure ◽  
Ross Operation ◽  
Pulmonary Autograft ◽  
Hemodynamic Profile ◽  
Children And Young Adults

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.

scholarly journals Long-term results of pulmonary autograft for aortic valve replacement.

Heart ◽  
1979 ◽  
Vol 42 (5) ◽  
pp. 533-540 ◽  
Author(s):  
J Somerville ◽  
O Saravalli ◽  
D Ross ◽  
S Stone
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Long Term Results ◽  
Pulmonary Autograft

scholarly journals The Pulmonary Autograft (Ross Operation) for Aortic Valve Endocarditis

1997 ◽  
Vol 2 (4) ◽  
pp. 302-317
Author(s):  
Gösla Pellersson ◽  
Frederic Joyce ◽  
Jens Tingleff
Keyword(s):  
Aortic Valve ◽  
Ross Operation ◽  
Pulmonary Autograft

scholarly journals Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation

Aorta ◽  
2015 ◽  
Vol 03 (06) ◽  
pp. 187-190 ◽  
Author(s):  
Vladimir Uspenskiy ◽  
Alexei Osadchii ◽  
Mikhail Gordeev
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Insufficiency ◽  
Computed Tomographic Angiography ◽  
Aortic Dilatation ◽  
Quadricuspid Aortic Valve ◽  
Severe Aortic Regurgitation ◽  
Computed Tomographic ◽  
Tomographic Angiography

AbstractThe quadricuspid aortic valve is a very uncommon malformation associated with aortic insufficiency, aortic stenosis, endocarditis, and ascending aortic dilatation. We report four cases of this aortic valve malformation. One patient with severe aortic regurgitation and moderate aortic dilatation required aortic valve replacement. Three patients had mild or moderate aortic insufficiency combined with moderate ascending aortic dilatation. These patients were referred to follow-up. The presented cases demonstrate that this aortic valve malformation may not be as rare as it appears and that attention must be paid to any quadricuspid findings during computed tomographic angiography and echocardiography.

scholarly journals Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (25) ◽  
pp. 2431-2442 ◽  
Author(s):  
Corrado Tamburino ◽  
Sabine Bleiziffer ◽  
Holger Thiele ◽  
Smita Scholtz ◽  
David Hildick-Smith ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Severe Aortic Regurgitation ◽  
Permanent Pacemaker Implantation ◽  
End Point ◽  
Transcatheter Aortic Valve

Background: Few randomized trials have compared bioprostheses for transcatheter aortic valve replacement, and no trials have compared bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and Efficacy Comparison of Two TAVI Systems in a Prospective Randomized Evaluation 2) was designed to compare the clinical outcomes of the ACURATE neo and CoreValve Evolut bioprostheses for transcatheter aortic valve replacement. Methods: SCOPE 2 was a randomized trial performed at 23 centers in 6 countries between April 2017 and April 2019. Patients ≥75 years old with an indication for transfemoral transcatheter aortic valve replacement as agreed by the heart team were randomly assigned to receive treatment with either the ACURATE neo (n=398) or the CoreValve Evolut bioprostheses (n=398). The primary end point, powered for noninferiority of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year. The key secondary end point, powered for superiority of the ACURATE neo bioprosthesis, was new permanent pacemaker implantation at 30 days. Results: Among 796 randomized patients (mean age, 83.2±4.3 years; mean Society of Thoracic Surgeons Predicted Risk of Mortality score, 4.6±2.9%), clinical follow-up information was available for 778 (98%) patients. Within 1 year, the primary end point occurred in 15.8% of patients in the ACURATE neo group and in 13.9% of patients in the CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95% confidence limit, 6.1%; P =0.0549 for noninferiority). The 30-day rates of new permanent pacemaker implantation were 10.5% in the ACURATE neo group and 18.0% in the CoreValve Evolut group (absolute risk difference, –7.5% [95% CI, –12.4 to –2.60]; P =0.0027). No significant differences were observed in the components of the primary end point. Cardiac death at 30 days (2.8% versus 0.8%; P =0.03) and 1 year (8.4% versus 3.9%; P =0.01), and moderate or severe aortic regurgitation at 30 days (10% versus 3%; P =0.002) were significantly increased in the ACURATE neo group. Conclusions: Transfemoral transcatheter aortic valve replacement with the self-expanding ACURATE neo did not meet noninferiority compared with the self-expanding CoreValve Evolut in terms of all-cause death or stroke at 1 year, and it was associated with a lower incidence of new permanent pacemaker implantation. In secondary analyses, the ACURATE neo was associated with more moderate or severe aortic regurgitation at 30 days and cardiac death at 30 days and 1 year. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03192813.

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