Factors impacting long-term pulmonary autograft durability after the Ross procedure

Sharifulin, Ravil; Bogachev-Prokophiev, Alexander; Железнев, С. И.; Демин, И. И.; Pivkin, Alexey; Afanasyev, Alexander; Караськов, А. М.

doi:10.1016/j.jtcvs.2018.05.046

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…The aortic root is prone to dilate in all patients presenting with conotruncal defects (7), which may finally lead to aortic regurgitation if the sinotubular junction is involved (8). The same is true for the PV in aortic position following an arterial switch operation for TGA, or following the Ross operation for AS and/or aortic regurgitation (9,10). Patients with congenital connecting tissue disorders like the Marfan syndrome or the Loeys-Dietz syndrome, as well as the patients with Turner syndrome, present with aortic dilatation and regurgitation, also.…”

Section: Surgery For Achd Is Predominantly Valve Surgerymentioning

confidence: 99%

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Hörer

2018

Cardiovasc. Diagn. Ther

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Today, more than two thirds of patients with congenital heart disease (CHD) are adults. Cardiac surgery plays an essential role in restoring and maintaining cardiac function, aside from evolving medical treatment and catheter-based interventions. The aim of the present publication was to describe the spectrum of operations performed on adults with CHD (ACHD) by reviewing current literature. Currently, surgery for ACHD is predominantly valve surgery, since valvular pathologies are often either a part of the basic heart defect or develop as sequelae of corrective or palliative surgery. Surgical techniques for valve repair, established in patients with acquired heart disease (non-ACHD), can often be transferred to ACHD. New valve substitutes may help to reduce the number of redo operations. Most of valve operations yield good results in terms of survival and quality of life, with the precondition that the ventricular function is preserved. Heart failure due to end-stage CHD is the most frequent cause of mortality in ACHD. However, surgical treatment by means of mechanical circulatory support (MCS) is still uncommon and the mortality exceeds the one following other operations in ACHD. Currently, different devices are used and new technical developments are in progress. However, there still is no ideal assist device available. Therefore, heart transplantation remains the only valid option for end-stage CHD. Despite higher early mortality following heart transplantation in ACHD compared to non-ACHD, the long-term survival compares favorably to non-ACHD. There is room for improvement by refining the indications, the time of listing, and the perioperative care of ACHD transplant patients. Sudden death is the second most frequent cause of mortality in ACHD. Ventricular tachycardia is the most frequent cause of sudden death followed by coronary artery anomaly. Due to the increasing awareness of physicians and the improved imaging techniques, coronary artery anomalies are coming more into the focus of cardiac surgeons. However, the reported experience is limited and it is currently difficult to provide a standardized and generally applicable recommendation for the indication and the adequate surgical technique. With the increasing age and complexity of ACHD, treatment of rhythm disturbances by surgical ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation and resynchronisation gains importance. A risk score specifically designed for surgery in ACHD is among the newest developments in predicting the outcome of surgical treatment of ACHD. This evidence-based score, derived from and validated with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database, enables comparison of risk-adjusted performance of the whole spectrum of procedures performed in ACHD and helps in understanding the differences in surgical outcomes. The score is thus a powerful tool for quality control and quality improvement. In conclusion, new developments in surgery for ACHD are currently made with regard to ...

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Section: Surgery For Achd Is Predominantly Valve Surgerymentioning

confidence: 99%

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Hörer

2018

Cardiovasc. Diagn. Ther

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“…The incidence of autograft regurgitation or autograft reoperation in previously reported series varied from 4% to 42%, 3 –6,11 –16 and the reported risk factors were previous AVR, 17 previous ventricular septal defect closure, 17 previous infective endocarditis, 18 preoperative aortic regurgitation 6,14 with bicuspid valve, 11 a larger aortic annulus or sinutubular junction, 14 younger age at the Ross procedure, 19 postoperative autograft regurgitation, 12 and the follow-up time after the Ross procedure. 3,5,6,17,18 In our study, 30.7% of patients had autograft failure at a median of 9.1 years after the Ross procedure.…”

Section: Commentmentioning

confidence: 97%

Outcome of Pulmonary Autograft After the Ross Procedure

Nakayama

Shinkawa

Matsumura

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: The purpose of this study was to assess autograft function after the Ross procedure and to review surgical outcomes associated with autograft reoperations. Methods: This is a retrospective study of patients undergoing the Ross procedure since 1993. Autograft function and autograft reoperation were studied. Autograft failure was defined as more than moderate autograft regurgitation or autograft dilatation to more than 50 mm diameter or z-score of more than +4 in children. One hospital death was excluded from analysis as were patients with unknown late autograft status. Results: Among 75 patients analyzed, preoperative diagnosis before the Ross procedure included aortic regurgitation in 26, aortic stenosis in 19, combined lesions in 28, and 2 mechanical valve malfunctions. Median age at the Ross procedure was 12.1 (0.4-43.6) years with 44 children less than 15 years old. Six patients had greater than mild autograft regurgitation at post-Ross hospital discharge. During median follow-up of 14.9 years, there were 23 autograft failures. Eighteen autograft reoperations were performed on 17 patients (13 children), including 12 aortic valve replacements, 5 aortic root replacements (including 1 valve-sparing root replacement), and 1 Konno procedure. Freedom from autograft failure and autograft reoperation at 20 years after the Ross procedure was 52.0% and 66.3%, respectively. Multivariate analysis identified greater than mild autograft regurgitation at hospital discharge from Ross procedure as a risk factor for autograft failure ( P < .01). All patients who underwent autograft reoperation survived and had good health status at a median of 6.9 years after the reoperation. Conclusions: The Ross procedure is effective in delaying prosthetic aortic valve replacement, although the time-related risk of autograft failure is a real consideration.

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“…Overall, there were 105 early deaths in 6,059 patients (1.73%) within thirty days of the initial operation. Data on stroke during the follow-up period was reported in thirteen studies (11)(12)(13)(14)(15)(16)(17)21,23,24,26,30,32). There were forty-six strokes reported (1.5%) in a patient population of 3,019 patients during the follow-up period.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Systematic review and meta-analysis of long-term outcomes in adults undergoing the Ross procedure

Flynn¹,

Bono²,

Muston³

et al. 2021

Ann Cardiothorac Surg

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Factors impacting long-term pulmonary autograft durability after the Ross procedure

Abstract: For patients undergoing the Ross procedure, a combination of bicuspid aortic valves and aortic insufficiency is the main risk factor for late autograft dilatation and dysfunction.

Cited by 15 publications

References 36 publications

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Current spectrum, challenges and new developments in the surgical care of adults with congenital heart disease

Outcome of Pulmonary Autograft After the Ross Procedure

Systematic review and meta-analysis of long-term outcomes in adults undergoing the Ross procedure

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