Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study

Abstract

We observed good late survival in patients undergoing autograft procedure without reinforcement techniques. However, over half of the autografts failed prior to the end of the second decade. The reoperation rate and the results of echocardiographic measurements over time underline the importance of careful monitoring especially in the second decade after the initial autograft operation and in particular in patients with pre-operative AR.

Congenital Heart Disease in the Older Adult

“…[358][359][360] Given the frequent need for reintervention after Ross procedure, the advantage over aortic valve replacement in the older adult has not been established. 361 …”

Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry

“…The relationship between pathological dilatation and onset of aortic valve insufficiency, well recognised in adult population, remains controversial 2 16 17. Certainly, freedom from autograft reoperation 20 years after Ross procedure in childhood is somewhat disappointing and not dissimilar to data in adults 5 7 8. Current estimates of 75% freedom from left heart reoperation at 15 years are apparently at odd with the German–Dutch registry at 10 years,5 but match well-institutional reports extending observations to 15 years 4.…”

“…Traditionally right heart conduit reconstruction has been considered the Achilles’ heel of paediatric Ross operation,2 – 5 whereas progressive dilatation of the autograft root has most often been identified with adaptive growth 6. In contrast, acquired autograft root (dilatation) and valve (dysfunction) disease have since been recognised as the main late sequelae in adults,7 thereby explaining the vanishing enthusiasm for the Ross procedure in this age group 8…”

Pulmonary autograft in aortic position: is everything known?

“…Moreover, the increased biomechanical stress of the pulmonary valve leaflet can promote faster structural valve degeneration with increased risk of adverse events in children undergoing somatic growth. Late autograft dysfunction in the root replacement technique is generally related to the progressive root dilatation, which leads to aneurism formation and aortic regurgitation, while autograft failure after implant in the subcoronary position is generally, but not exclusively, caused by leaflet dysfunction (34,(52)(53)(54)(55)(56).…”