Mechanical valves versus the Ross procedure for aortic valve replacement in children: Propensity-adjusted comparison of long-term outcomes

Alsoufi, Bahaaldin; Al‐Halees, Zohair; Manlhiot, Cedric; McCrindle, Brian W.; Al-Ahmadi, Mamdouh; Sallehuddin, Ahmed; Canver, Charles C.; Bulbul, Ziad; Joufan, M.; Fadel, Bahaa M.

doi:10.1016/j.jtcvs.2008.10.010

Cited by 92 publications

(73 citation statements)

References 25 publications

(46 reference statements)

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“…Wilder et al [1] have reported an important series of 90 children operated for significant aortic regurgitation in recent years in a single institution. The children received either aortic valve repair (51%), the Ross procedure (23%) or valve replacement with a prosthesis [aortic valve replacement (AVR), 26%].…”

Section: Conflict Of Interest: None Declaredmentioning

confidence: 99%

“…Mechanical and bioprosthetic aortic valve replacement (AVR) may result in patient-prosthesis size mismatch, prosthesis outgrowth and lifestyle limitations or complications resulting from anticoagulation [1]. Ross procedures (AVR using pulmonary autograft) provide solutions to some of these limitations in that the autograft continues to grow and does not require anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

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Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation

Wilder

Caldarone

Arsdell

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES:To evaluate the durability of aortic valve (AoV) repair relative to other strategies for children with significant aortic insufficiency (AI). METHODS:From 2001 to 2012, 90 children with greater than or equal to moderate AI underwent surgery. Resulting procedures were classified according to final operative outcome: AoV repair (repair; n = 46, 51%), Ross procedure (Ross; n = 21, 23%) or replacement with mechanical or tissue prosthesis [aortic valve replacement (AVR); n = 23, 26%]. Repeated measures (n = 1081 echocardiograms) mixedmodel analysis and parametric multiphase risk-adjusted hazard analysis were used to evaluate haemodynamic parameters and durability of operations.RESULTS: Mean age at operation was similar for repair and Ross groups, but slightly higher for the AVR group (10.6, 11 and 13.2, respectively; P = 0.04). Baseline annular dimensions were similar among groups. Of 46 repairs, 85% involved pericardial leaflet extensions (commonly with leaflet shaving and/or commisuroplasty). The remaining repairs were commissuroplasties. On multivariable analysis, repair was associated with increased early ( 1-2 years) AI and increased outflow tract peak pressure gradients relative to Ross and AVR procedures. On univariate analysis, repairs tended to have a larger annulus size compared with Ross or AVR; however, this was not significant on multivariable analysis. There were 25 reinterventions (surgical reoperation = 16; transcatheter intervention = 9) for 22 children. Freedom from surgical reoperation was 64, 100 and 51% at 6 years for repairs, Ross and AVR, respectively (P = 0.05); however, three of five reoperations after AVR were for failed bioprosthetic devices. The freedom from reintervention was not significantly influenced by the type of AoV operation (P = 0.43).CONCLUSIONS: Durability of aortic valve repair for children is limited by recurrence of AI and/or stenosis, often within the first few years. After repair, reoperation should be anticipated within 7 years.

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Section: Conflict Of Interest: None Declaredmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation

Wilder

Caldarone

Arsdell

et al. 2015

Eur J Cardiothorac Surg

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“…Although mechanical valves are durable, they have many disadvantages including the necessity for life-long anticoagulation, risks of endocarditis, bleeding, and thromboembolic events. [6,7] Even reoperation is required in at least 10% of mechanical valves by 20 years for endocarditis, paravalvular leak, thrombotic, or hemorrhagic complications or pannus formation with obstruction. Mechanical valves are also more problematic in female patients in childbearing age who need aortic valve replacement, leading to severe social and psychological distress.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical valves are also more problematic in female patients in childbearing age who need aortic valve replacement, leading to severe social and psychological distress. [6,7] Although bioprosthetic valves do not require anticoagulation, their long-time durability is not optimal in young patients. [4] The ideal valve substitute in children, therefore, should have somatic growth, no need for anticoagulation with excellent hemodynamic properties, resistance to infection, and long-term durability.…”

Section: Discussionmentioning

confidence: 99%

The Ross and Ross-Konno operations for congenital aortic valve diseases in infants and children

Erek¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada doğuştan aort darlığı olan çocuk hastalarda Ross ve Ross-Konno ameliyatının erken ve orta dönem sonuçları bildirildi.Ça lış mapla nı:Ocak 2011 -Aralık 2015 tarihleri arasında doğuştan aort darlığı ön tanısı ile Ross veya Ross-Konno ameliyatı yapılan toplam sekiz hasta (4 erkek, 4 kız; medyan yaş 4.5 yıl; dağılım, 3-17 yıl) retrospektif olarak incelendi. Kardiyopulmoner baypas ve kros-klemp süresi ve yoğun bakım ünitesi ve hastanede yatış süresi kaydedildi. Bul gu lar:Yedi hastaya daha önce girişim uygulanmıştı [balon valvuloplasti (n=4), ventriküler septal defekt tamiri (n=1), aort kapak tamiri (n=1) ve aort koarktasyon tamiri (n=1)]. Beş hastaya Ross-Konno ameliyatı yapılırken, geri kalan üç hastaya Ross ameliyatı yapıldı. İki hastada ilave subaortik rezeksiyon ve bir hastada mitral kapak tamiri gerekli oldu. Erişkin boyutundaki hastaya Dacron kondüit ile pulmoner otogreft wrapping yapıldı. Mortalite ve majör morbiditeye rastlanmadı. Ortalama kardiyopulmoner baypas ve kross klemp süresi sırasıyla 234±6 ve 177±4 dk idi. İki hastanın sternumu sonradan kapatıldı. Medyan yoğun bakım ünitesi ve hastane kalış süreleri sırasıyla 4.5 ve 13.5 gün idi. Ortalama takip süresi, 29.3±15.6 ay (dağılım, 3 ay -4 yıl) idi. Yalnızca iki hastada hafif ila orta düzeyde pulmoner kondüit darlığı vardı. Son takip vizitinde hiçbir hastada orta veya ciddi aort kapak yetmezliği görülmedi.So nuç: Çalışma bulgularımız, pulmoner otogreft ve pulmoner kondüit fonksiyonlarının orta dönem takipte çok iyi olduğunu göstermektedir. Bu bulgulara dayanarak, bebeklerde ve çocuklarda aort kapak replasmanı için Ross ve Ross-Konno ameliyatları, düşük mortalite oranları ile iyi birer seçenektir.Anah tarsöz cük ler: Aort kapak darlığı; otogreft; doğuştan kalp hastalığı. ABSTRACTBackground:In this study, we present early and mid-term outcomes of Ross and Ross-Konno operation in pediatric patients with congenital aortic stenosis.

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“…Although current mechanical and biological heart valve replacements improve patient survival and quality of life, problems such as thrombosis, infection and limited durability still occur and none of the current conventional valve replacements has the capacity to grow in young patients (Alpert and Dalen, 1987;Roudaut et al, 2007;Kidane et al, 2009). For young patients under the age of 18 years with severe aortic heart valve disease, the Ross procedure using a pulmonary autograft is the preferred replacement valve substitute (Alsoufi et al, 2009). A cryopreserved pulmonary allograft is then implanted in the right ventricular outflow tract (RVOT), although these have limitations including variability in their durability.…”

Section: Introductionmentioning

confidence: 99%

In vitro biomechanical and hydrodynamic characterisation of decellularised human pulmonary and aortic roots

Desai

Vafaee

Rooney

et al. 2018

Journal of the Mechanical Behavior of Biomedical Materials

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A B S T R A C TBackground and purpose of the study: The use of decellularised biological heart valves in the replacement of damaged heart valves offers a promising solution to reduce the degradation issues associated with existing cryopreserved allografts. The purpose of this study was to assess the effect of low concentration sodium dodecyl sulphate decellularisation on the in vitro biomechanical and hydrodynamic properties of cryopreserved human aortic and pulmonary roots. Method: The biomechanical and hydrodynamic properties of cryopreserved decellularised human aortic and pulmonary roots were fully characterised and compared to cellular human aortic and pulmonary roots in an unpaired study. Following review of these results, a further study was performed to investigate the influence of a specific processing step during the decellularisation protocol ('scraping') in a paired comparison, and to improve the method of the closed valve competency test by incorporating a more physiological boundary condition. Results: The majority of the biomechanical and hydrodynamic characteristics of the decellularised aortic and pulmonary roots were similar compared to their cellular counterparts. However, several differences were noted, particularly in the functional biomechanical parameters of the pulmonary roots. However, in the subsequent paired comparison of pulmonary roots with and without decellularisation, and when a more appropriate physiological test model was used, the functional biomechanical parameters for the decellularised pulmonary roots were similar to the cellular roots. Conclusion: Overall, the results demonstrated that the decellularised roots would be a potential choice for clinical application in heart valve replacement.

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Mechanical valves versus the Ross procedure for aortic valve replacement in children: Propensity-adjusted comparison of long-term outcomes

Cited by 92 publications

References 25 publications

Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation

Aortic valve repair for insufficiency in older children offers unpredictable durability that may not be advantageous over a primary Ross operation

The Ross and Ross-Konno operations for congenital aortic valve diseases in infants and children

In vitro biomechanical and hydrodynamic characterisation of decellularised human pulmonary and aortic roots

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