A modified Ross operation to prevent pulmonary autograft dilatation

Abstract

A modification in Ross operation is described in which the free-standing pulmonary autograft root is suspended in a Dacron prosthetic vascular jacket with a view to prevent dilatation of the neo-aortic root. In a group of 13 patients operated consecutively using this technique, there was no significant increase in the diameters of the neo-aortic root after a mean 16-month follow-up. Aortic valve function remained also satisfactory.

The Ross procedure using autologous support of the pulmonary autograft: Techniques and late results

“…Unfortunately, despite mostly guaranteeing early valve competence, this technique has suffered an even higher reoperation rate in most reported series 21-24 because of late aortic root dilatation often with concomitant development of increasing AR, with most reoperations occurring as patients enter the second decade of follow-up. Since then, an abundance of techniques have arisen to support the autograft, initially at the annular and STJ levels 25-28 and more recently partial or complete support of the autograft root, with synthetic materials [4][5][6] or autologous support, 7,8 as practiced by our group. Beginning in 1992, 322 (or 93%) of all patients receiving an RP at our institution have had this method used to support the autograft within the patient's own aorta, which has been adjusted mostly by reducing its size to act as a scaffold to prevent the autograft from dilating later.…”

“…1-3 A myriad of Ross operative techniques have evolved to stabilize the aortic root geometry and prevent PA dilatation and the subsequent development of aortic regurgitation (AR), a common mode of late RP failure. [4][5][6] The described autologous external support technique of the PA demonstrates superior long-term outcomes in patients suitable for the RP. 7,8 Surgical techniques to rigorously remodel the diameter of the native aortic annulus, aortic root, and ascending aorta allow native aortic tissue to be used to create aortic geometry mirroring normal for the patient's size.…”

An experimental model of the Ross operation: Development of resorbable reinforcements for pulmonary autografts

“…Designed to address the problem of autograft root dilatation, various methods of pulmonary artery trunk reinforcement with a prosthesis have produced encouraging results. [23][24][25] However, these data came from single centers or single-surgeon, individual experience. Complete sets of experimental activities are needed to help enable a full evaluation of the morphologic, pathologic, and hemodynamic aspects of the proposed reinforcement strategy, and more importantly, a progressive follow-up of the vascular changes during growth.…”

Routine use of self-expanding venous cannulas for cardiopulmonary bypass: benefits and pitfalls in 100 consecutive cases☆

“…Considering the growing number of indications for remote venous cannulation, which follows the development for small access open-heart surgery [16,17], as well as the growth of redo open-heart surgery [18,19], and other complex procedures [20,21], the advent of self-expanding venous cannulas is a major step forward in optimization of cardiopulmonary bypass. Better venous drainage with remote venous cannulation not only allows for higher pump flows and improved end-organ perfusion, but is also essential for a bloodless operative field, which in turn simplifies the surgical procedure.…”