Quo Vadis Pulmonary Autograft—The Ross Procedure in Its Second Decade: A Single-Center Experience in 645 Patients

The David Procedure for Salvage of a Failing Autograft After the Ross Operation

“…Interestingly, those complex reoperations were performed with a remarkably low mortality of 1.8%, and also included disorders not related to the initial Ross operation. We reported a freedom from reoperation on the neoaortic root of 92% at 12 years, confirming excellent long-term results reported by others [9,13,16]. Early autograft failure within 1 year of the initial procedure occurred in 1.7% of patients, but was primarily related to technical errors or endocarditis and not as a result of the root disease seen in late autograft failure.…”

“…This has been described especially when using a freestanding autograft root replacement, and even exceeds the prevalence of right-sided dysfunction of the homograft in some studies [19,20]. However, we have previously reported excellent survival and low reoperation rates when using a reinforced full root technique [13]. The mechanisms involved in a failing pulmonary autograft are by nature similar to those observed in the native aortic valve with dilatation of the aortic root [21].…”

“…Both techniques have been previously described in detail [4,13,14]. In the later series (1999-2012), a Dacron (polyethylene terephthalate fiber) strip was incorporated into the proximal suture line, and a second suture line fixed the aortic wall remnant to the autograft to provide reinforcement and prevent autograft dilatation [13].…”

“…Reoperations could be performed with low perioperative morbidity and mortality. numerous advantages compared with other treatment strategies of aortic valve disease, which include excellent hemodynamic function, freedom from lifelong anticoagulation, unrestricted daily activities, superior quality of life, and a normal life expectancy [1][2][3][4][5][6][7][8][9][10][11][12][13]. In the late 1980s, Stelzer and colleagues [14] made the Ross operation easier to reproduce by introducing the full freestanding root technique.…”

Lethality predictors in adults undergoing Ross procedure: analysis of 760 operations

“…Авторы отвечают на вопрос результатами собственного анализа 645 боль-ных (1995-2012 гг. ): госпитальная летальность соста-вила 0,9% (n = 6), кумулятивная выживаемость к 15-му году 92,7% не отличалась от таковой для популяции (р = 0,261), а свобода от повторных операций на ауто-трансплантате или гомографте к 12-му году были 91,6 и 95,0% соответственно [8].…”