Disproportionate enlargement of the pulmonary autograft in the aortic position in the growing pig

Schoof, Paul H.; Hazekamp, Mark G.; Wermeskerken, Gijs van; Heer, Emile de; Bruijn, Jan A.; Groot, Adriana Gittenberger-de; Huysmans, Hans A.

doi:10.1016/s0022-5223(98)70208-9

Cited by 32 publications

(24 citation statements)

References 17 publications

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“…In this study, the only independent predictors of aortic size were age at Ross procedure, BSA and peak systolic BP. The inverse relation between aortic size and the age at Ross procedure could be explained by the fact that autografts placed in younger patients have longer exposure to dilatory stimuli released during periods of growth and are therefore more likely to dilate 12 13. The relation between aortic size and BSA may simply be due to the autograft responding to adult somatic growth.…”

Section: Discussionmentioning

confidence: 99%

Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing

Puranik

Tsang

Broadley

et al. 2009

Heart

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Section: Discussionmentioning

confidence: 99%

Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing

Puranik

Tsang

Broadley

et al. 2009

Heart

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“…Despite the growth and dilatation, the pulmonary autograft wall still showed pulmonary characteristics both micro-and macroscopically after implantation in aortic position [4].…”

Section: Introductionmentioning

confidence: 96%

Biomechanical evaluation of a personalized external aortic root support applied in the Ross procedure

Vastmans

Fehervary

Verbrugghe

et al. 2018

Journal of the Mechanical Behavior of Biomedical Materials

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A commonly heard concern in the Ross procedure, where a diseased aortic valve is replaced by the patient's own pulmonary valve, is the possibility of pulmonary autograft dilatation. We performed a biomechanical investigation of the use of a personalized external aortic root support or exostent as a possibility for supporting the autograft. In ten sheep a short length of pulmonary artery was interposed in the descending aorta, serving as a simplified version of the Ross procedure. In seven of these cases, the autograft was supported by an external mesh or so-called exostent. Three sheep served as control, of which one was excluded from the mechanical testing. The sheep were sacrificed six months after the procedure. Samples of the relevant tissues were obtained for subsequent mechanical testing: normal aorta, normal pulmonary artery, aorta with exostent, pulmonary artery with exostent, and pulmonary artery in aortic position for six months. After mechanical testing, the material parameters of the Gasser-Ogden-Holzapfel model were determined for the different tissue types. Stress-strain curves of the different tissue types show significantly different mechanical behavior. At baseline, stress-strain curves of the pulmonary artery are lower than aortic stress-strain curves, but at the strain levels at which the collagen fibers are recruited, the pulmonary artery behaves stiffer than the aorta. After being in aortic position for six months, the pulmonary artery tends towards aorta-like behavior, indicating that growth and remodeling processes have taken place. When adding an exostent around the pulmonary autograft, the mechanical behavior of the composite artery (exostent + artery) differs from the artery alone, the non-linearity being more evident in the former.

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“…The failure of regurgitation to deteriorate with time indicates maintained valve function, which may be attributed to growth and remodeling of the valve cusps. This phenomenon of passive dilatation of the pulmonary autograft was demonstrated by Schoof and colleagues 16 in their animal study. However, in clinical practice, progressive dilatation leading to signifi cant regurgitation has been reported only in a small number of cases with the pulmonary valve placed in the systemic circulation.…”

Section: Discussionmentioning

confidence: 55%

Growth of Pulmonary Autograft after Ross Operation in Pediatric Patients

Raja

Pozzi

2004

Asian Cardiovasc Thorac Ann

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The Ross procedure is being used increasingly to treat aortic valve disease in pediatric patients; however, there is an ongoing dispute about the durability of the autograft. From November 1996 to September 2003, 32 pediatric patients (mean age, 11 +/- 4.5 years) underwent the Ross procedure for various aortic valve diseases, using the root replacement technique. Clinical and echocardiographic follow-up was performed early (within 30 days), at 3 to 6 months, and yearly after surgery. There were no perioperative deaths. The patients were followed-up for up to 7 years with a median interval of 36 months. Actuarial survival at 7 years was 96% +/- 3% and there was 100% freedom from re-operation for autograft valve dysfunction or any other cause. The autograft annulus and sinus increased significantly in size during follow-up and the increase in size paralleled the increase in body surface area, with no evidence of disproportional dilatation. The hemodynamics at the latest follow-up were also similar to those at the time of discharge after surgery. Pulmonary autograft replacement of the aortic valve appears to be the ideal solution in pediatric patients, because of relatively low operative risk, excellent late valve function, and real potential for growth.

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Disproportionate enlargement of the pulmonary autograft in the aortic position in the growing pig

Cited by 32 publications

References 17 publications

Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing

Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing

Biomechanical evaluation of a personalized external aortic root support applied in the Ross procedure

Growth of Pulmonary Autograft after Ross Operation in Pediatric Patients

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