Aortic Root and Ascending Aortic Replacement Bentall or Ross Procedure?

Abstract

SummaryThe Ross procedure is occasionally favoured in young adults, with the implantation of a mechanical conduit remaining a competing option when simultaneous replacement of the ascending aorta is indicated.Eighteen patients with replacement of the ascending aorta, in addition to the Ross procedure (Ross), and 20 patients with a mechanical composite graft (composite) were compared retrospectively. The Short Form Health Survey (SF36) was used to assess quality of life (QoL).There was one death due to ischemic heart disease (composite), and one reoperation due to progressive autograft regurgitation (Ross). Autografts had pressure gradients of 3.1 ± 1.9 mmHg (versus 10.8 ± 2.7 mmHg composite; P < 0.001), and 7 autografts showed mild regurgitation. LV mass and global LV function were comparable in both groups (mean EF, 65.5% in Ross versus 61.6 ± 10.4% in composite, P = NS). Four allografts in a pulmonary position had mild regurgitation (Ross). Two allografts had mild to moderate, and one had moderate pressure gradients (mean, 14.4 mmHg). Patients in the composite group had higher SF36 scores indicating superior QoL. No major bleeding was noted throughout the follow-up period.Despite pre-OP diminished LV function, similar follow-up values and, surprisingly, a higher QoL outcome, favoured the implantation of mechanical conduits in our group. These results warrant further evaluation in larger patient cohorts. (Int Heart J 2009; 50: 47-57) Key words: Aortic valve replacement, Heart valve autograft, Heart valve mechanical, Ross operation, Quality of life The pulmonary autograft procedure for the surgical treatment of aortic valve disease was introduced in 1967 by Donald Ross 1) as an alternative to the prosthetic valves and the aortic allograft. This procedure employs an autologous pulFrom the

Ross Procedure vs Mechanical Aortic Valve Replacement in Adults

“…A total of 18 studies were included in the analysis: 1 randomized clinical trial (5.6%), 26 10 matched/adjusted observational studies (55.6%), [27][28][29][30][31][32][33][34][35][36] and 7 unmatched/unadjusted observational studies (38.9%) (eFigure 1 in Supplement 1). [37][38][39][40][41][42][43] The selected studies included a total of 3516 patients, of whom 1552 (44.1%) underwent a Ross procedure, and 1964 (55.9%) underwent mechanical aortic valve replacement. Characteristics of the included studies are presented in the Table . Study size ranged from 11 to 692 patients.…”

Which Valve to Who: Prosthetic Valve Selection for Aortic Valve Surgery

“…In the study of Akhyari and colleagues, pulmonary autograft had no advantages over composite grafts regarding mid-term morbidity and mortality in aortic position (Akhyari, 2009). …”

“…This technique was introduced in 1967 by Donald Ross (Ross, 1967). The benefits of the Ross procedure are the superior durability of the pulmonary autograft when compared to biological valves in the aortic position, the growth potential of the autograft, and avoidance of prolonged anticoagulation (Akhyari, 2009). Hence, this procedure is primarily used in young or growing patients.…”

Measuring what matters to the patient: health related quality of life after aortic valve and thoracic aortic surgery

“…Two studies [ 26 , 27 ] investigated HRQoL using SF-36, EuroQoL, the Seattle Angina Questionnaire (SAQ), and the Hospital Anxiety and Depression Scale (HADS) in patients after composite graft root replacement, comparing mechanical and tissue valves (Ross procedure and biological valves). Both studies found comparable HRQoL outcomes between the two groups for all instruments used.…”