Aortic dissection after the Ross procedure

Siudalska, Hanna; Kuśmierczyk, Mariusz; Różański, Jacek; Petryka-Mazurkiewicz, Joanna; Kumor, Magdalena; Michałowska, Anna; Michałowska, Ilona

doi:10.33963/kp.15957

Cited by 3 publications

(4 citation statements)

References 4 publications

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“…При отсутствии значимой аортальной регургитации хирургическое вмешательство нами выполняется при диаметре 55 мм, при значимой аортальной регургитации при диаметре неаорты 45 мм. Ряд авторов описали случаи диссекции аорты тип А после операции Росса [29][30][31]. Недавно Kalogerakos PD, et al [32] пришли к выводу, что дилатация корня аорты более злокачественна, чем дилатация средневосходящей части аорты.…”

Section: Discussionunclassified

“…С апреля 2009г по декабрь 2020г выполнено 212 операций Росса пациентам 18 лет и старше. Медиана возраста оперированных больных составила 34 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) The David procedure after the Ross operation: case series…”

Section: операция дэвида после росса: серия клинических случаевunclassified

“…From April 2009 to December 2020, 212 Ross operations were performed on patients 18 years of age and older. The median age of the operated patients was 34 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) years. In the long-term period, 10 (4,7%) patients required a second AV operation and 7 (3,3%) of them required another intervention on the ascending aorta due to aortic dilatation.…”

Section: операция дэвида после росса: серия клинических случаевmentioning

confidence: 99%

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The David procedure after the Ross operation: case series

et al. 2021

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Pulmonary autograft in the aortic position provides high survival rate and quality of life for patients, low incidence of valve-related complications, and excellent hemodynamic characteristics both in the early and long-term period. However, in some patients in the long-term period, pulmonary autograft may dilate, which in turn is one of the reasons for reoperations. In patients who require surgery for annuloaortic ectasia with aortic valve (AV) regurgitation or aortic root aneurysm (or both) with normal AV leaflets, David procedure is considered.Aim. To analyze results of David procedure after a prior Ross operation.Material and methods. From April 2009 to December 2020, 212 Ross operations were performed on patients 18 years of age and older. The median age of the operated patients was 34 (27-45) years. In the long-term period, 10 (4,7%) patients required a second AV operation and 7 (3,3%) of them required another intervention on the ascending aorta due to aortic dilatation. Four out of 10 patients underwent David procedure. The follow-up period for patients after David procedure ranged from 2 to 84 months.Results. The age of patients ranged from 23 to 45 years. Three patients had hypertension. The follow-up period from Ross's operation to David's one was 26 to 140 months. All patients had enlarged aortic annulus from 27 to 30 mm. The duration of myocardial ischemia ranged from 87 to 142 minutes, while the duration of artificial circulation — from 119 to 165 minutes. The graft diameter was 30 mm in two patients and 32 mm in the remaining ones. The length of stay in intensive care unit ranged from 16 to 23 hours. In the early postoperative period, no one had following postoperative complications: acute renal failure requiring hemodialysis, perioperative myocardial injury, stroke, sternal infection, respiratory failure requiring mechanical ventilation for ≥24 hours, resternotomy for bleeding and tamponade. In addition, there were no in hospital deaths. All patients had no aortic regurgitation at the time of discharge. All patients are alive and there were no reoperations. In one patient, in the long-term period, there was a mild aortic regurgitation, while in three patients — there is no regurgitation.Conclusion. The presented case series show that David procedure can be performed safely and effectively in a significant number of patients requiring a second autograft surgery due to neosinus dilatation. In the medium term, the David procedure has shown good outcomes in these patients with 100% survival and no aortic regurgitation and reoperation.

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Section: Discussionunclassified

Section: операция дэвида после росса: серия клинических случаевunclassified

Section: операция дэвида после росса: серия клинических случаевmentioning

confidence: 99%

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The David procedure after the Ross operation: case series

et al. 2021

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“…While less straightforward than for genetically determined aortic aneurysms, there appears to be an association between autograft diameter and dissection. Pulmonary autograft dissection has been described in at least 9 cases, occurring between 5 and 18 years after index surgery at an autograft diameter of 54-64 mm (49)(50)(51)(52)(53)(54)(55)(56)(57). All patients presented with aortic insufficiency related to a bicuspid aortic valve (BAV) at initial operation.…”

Section: Clinical Failure Mechanismsmentioning

confidence: 99%

Understanding Pulmonary Autograft Remodeling After the Ross Procedure: Stick to the Facts

Hoof

Verbrugghe

Jones

et al. 2022

Front. Cardiovasc. Med.

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The Ross, or pulmonary autograft, procedure presents a fascinating mechanobiological scenario. Due to the common embryological origin of the aortic and pulmonary root, the conotruncus, several authors have hypothesized that a pulmonary autograft has the innate potential to remodel into an aortic phenotype once exposed to systemic conditions. Most of our understanding of pulmonary autograft mechanobiology stems from the remodeling observed in the arterial wall, rather than the valve, simply because there have been many opportunities to study the walls of dilated autografts explanted at reoperation. While previous histological studies provided important clues on autograft adaptation, a comprehensive understanding of its determinants and underlying mechanisms is needed so that the Ross procedure can become a widely accepted aortic valve substitute in select patients. It is clear that protecting the autograft during the early adaptation phase is crucial to avoid initiating a sequence of pathological remodeling. External support in the freestanding Ross procedure should aim to prevent dilatation while simultaneously promoting remodeling, rather than preventing dilatation at the cost of vascular atrophy. To define the optimal mechanical properties and geometry for external support, the ideal conditions for autograft remodeling and the timeline of mechanical adaptation must be determined. We aimed to rigorously review pulmonary autograft remodeling after the Ross procedure. Starting from the developmental, microstructural and biomechanical differences between the pulmonary artery and aorta, we review autograft mechanobiology in relation to distinct clinical failure mechanisms while aiming to identify unmet clinical needs, gaps in current knowledge and areas for further research. By correlating clinical and experimental observations of autograft remodeling with established principles in cardiovascular mechanobiology, we aim to present an up-to-date overview of all factors involved in extracellular matrix remodeling, their interactions and potential underlying molecular mechanisms.

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Pulmonary Autograft Dilatation and its Risk Factors After Classical Ross Procedure: a Retrospective Single Center Study

Чернов

Энгиноев

Зеньков

et al. 2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. Aortic valve replacement with pulmonary autograft (Ross procedure) demonstrated excellent immediate and long-term results. Dilation of the pulmonary autograft in the long-term period is the main reason for repeated surgery. Aim: to study the prevalence of pulmonary autograft dilatation and its risk factors. Materials and methods. From April 2009 to December 2022, 158 patients underwent classical Ross surgery. Inclusion criteria: patients aged 18 and older, patients who underwent classical surgery. Exclusion criteria: patients under 18, modifi ed methods of Ross procedure. Follow-up period: 104 (49–124) months. Results and discussion. The median age of patients was 33 (25–43) years. Hospital mortality accounted for 0.6 %. Perioperative myocardial injury was 3.8 %, conduction disorder requiring permanent pacemaker implantation accounted for 1.9 %, the incidence of strokes and acute kidney injury requiring hemodialysis was 0.6 %. Ten-year freedom from autograft reoperation was 88.4. Ten-year freedom from reoperation for aortic aneurysm accounted for 92 %. Predictors of autograft dilatation in the long-term period were: age (OR: 0.942; 95% CI: 0.901–0.984, p = 0.008) and the initial size of sinuses of Valsalva (OR: 1.18; 95% CI: 1.027–1.215, p = 0.01). Conclusion. Ten-year freedom from autograft reoperation due to aortic dilatation and freedom from aortic dilatation ≥ 45 mm was 92 % and 37.2 %, respectively. The main predictors of autograft dilatation in the postoperative period are the age and the initial diameter of the sinuses of Valsalva.

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Aortic dissection after the Ross procedure

Cited by 3 publications

References 4 publications

The David procedure after the Ross operation: case series

The David procedure after the Ross operation: case series

Understanding Pulmonary Autograft Remodeling After the Ross Procedure: Stick to the Facts

Pulmonary Autograft Dilatation and its Risk Factors After Classical Ross Procedure: a Retrospective Single Center Study

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