Midterm Results of the Ross Procedure Preserving the Patient’s Aortic Root

Abstract

Background-Since the early 1990s, the pulmonary autograft is predominantly implanted as a freestanding root for less aortic valve regurgitation is reported. However, there is a certain risk of dilatation of the root over time potentially impairing valve function. We favor since 8 years the original subcoronary or inclusion technique to preserve the root of the patient as a restrain to dilatation. Methods and Results-Between June 1994 and May 2002 the subcoronary (nϭ228) and inclusion technique (nϭ17) were performed in 245 patients (191 male, 54 female), mean age 45.7Ϯ13.4 (15-70) years. The underlying aortic valve disease was an aortic insufficiency in nϭ83, stenosis in nϭ48, a combined aortic valve disease in nϭ111 and an acute endocarditis in nϭ19 patients. Previous aortic valve surgery was performed in nϭ23. Last follow-up investigations (within last year) including echocardiography was performed at a mean follow-up of 29.4Ϯ24.7 months (553.7 patient years). Hospital mortality was nϭ2, late mortality nϭ4 (all noncardiac). Two patients were lost to follow-up (99% complete clinical follow-up). Reoperations were necessary in nϭ7 valves (autograft: endocarditis nϭ1, malpositioning nϭ1, leaflet prolapse nϭ1; homograft: stenosis nϭ2, insufficiency nϭ2). Autograft insufficiency (AI) was AI 0 in nϭ154, AI I nϭ66, AI II nϭ8. The maximum/mean pressure gradient across the autograft was 6.6Ϯ3.4 (2.1 to 25.9)/3.6Ϯ1.8 (1.2 to 13.2) mm Hg, respectively. Homograft insufficiency was 0 in nϭ167, I in nϭ54, II in nϭ9, and III in nϭ1. Maximum and mean transhomograft pressure gradients were 11.7Ϯ6.8 (2.2 to 42.6)/6.2Ϯ3.8 (1.2 to 24.5) mm Hg. Most patients were NYHA class I (nϭ214), class II (nϭ19), class III (nϭ2). Significant aortic root dilatation was not observed. Conclusions-Aortic

Ross Procedure in Children: 17‐Year Experience at a Single Institution

“…24 Inclusion, sub-coronary, and reinforcement techniques to improve the durability of the autograft have been utilized in adult populations and mid-term results have been promising. 16,17,[25][26][27] However, stabilization of the neoaortic root that would, at the same time, permit somatic growth is challenging in children. In our study, 40% of patients did not have any AI, 53% had trivial to mild AI and 7% had moderate to severe AI.…”

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound

“…16 Using color Doppler, the severity of PR is graded on the basis of the components of the jet, including regurgitant jet width, vena contracta, and its penetration depth into the RV outflow. [166][167][168][169][170][171][172][173] Some authors have assessed the severity by jet width, in a manner analogous to that described for AR. 174 A thin narrow jet <25% of the pulmonary annulus is generally considered mild, and a wide jet >50% of the pulmonary annulus is severe.…”

Midterm thromboembolic and bleeding complications are minimal after composite graft replacement of the aortic root

“…One certainly wonders, from our results, especially recognizing the relatively flat curve for thromboembolism and bleeding in Figure 2, whether the putative advantages of the Ross or valve-sparing procedures are great enough to forfeit the known durability of traditional composite graft replacement. One must also bear in mind that even the most recent reports of experience with the alternate procedures do not exceed midterm followup, with precious few patients beyond the five-year point [13][14][15][16][17][18]. Our intent is not to detract in any way from the Ross or valve-sparing procedures, which have great merits.…”