Technical evolution of the Ross operation: midterm results in 186 patients

Böhm, J.; Botha, Cornelius A; Rein, J; Röser, D

doi:10.1016/s0003-4975(01)02542-5

Cited by 23 publications

(5 citation statements)

References 13 publications

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“…5,11,12 For example, when comparing the annual stroke rate of the study group receiving the Ross procedure with the incidence rates of stroke from a community-based study of stroke in Germany, the event rate of 1.57 events/year per 1000 patients was similar to the expected event rate from the community study (annual incidence rate 1.82 events/year per 1000 patients). 13 The survival rate is excellent, and rate of reoperation of the autograft in the present subcoronary implantation cohort is low, similar to other operative techniques in the midterm follow-up.…”

Section: Discussionmentioning

confidence: 73%

A Critical Reappraisal of the Ross Operation

et al. 2006

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Background-The autograft procedure, an option in aortic valve replacement, has undergone technical evolution. A considerable debate about the most favorable surgical technique in the Ross operation is still ongoing. Originally described as a subcoronary implant, the full root replacement technique is now the most commonly used technique to perform the Ross principle. Methods and Results-Between June of 1994 and June of 2005, the original subcoronary autograft technique was performed in 347 patients. Preoperative, perioperative, and follow-up data were collected and analyzed. Mean patient age at implantation was 44Ϯ13 years (range 14 to 71 years; 273 male, 74 female). Bicuspid valve morphology was present in 67%. The underlying valve disease was aortic regurgitation in 111 patients, stenosis in 46 patients, combined lesion in 188 patients, and active endocarditis in 22 patients (in 2 patients without stenosis or regurgitation). Concomitant procedures were performed in 130 patients. Clinical and echocardiographic follow-up visits were obtained annually (mean follow up 3.9Ϯ2.7 years, 1324 patient-years; completeness of follow-up 99.4%). The in-hospital mortality rate was 0.6% (n ϭ2), and the late mortality was 1.7% (nϭ6), with 5 noncardiac deaths (4 cancer, 1 multiorgan failure after noncardiac surgery) and 1 cardiac death (sudden death). At last follow-up, 94% of the surviving patients were in New York Heart Association class I. Ross procedure-related valvular reoperations were necessary in 9 patients: Three received autograft explants, 5 received homograft explants, and 1 received a combined auto-and homograft explant. At last follow-up visit, autograft/homograft regurgitation grade II was present in 5/10 patients and grade III in 4/0. Maximum/mean pressure gradients were 7.4Ϯ6.2/3.7Ϯ2.1 mm Hg across the autograft and 15.3Ϯ9.4/ 7.6Ϯ5.0 mm Hg across the right ventricular outflow tract, respectively. Aortic root dilatation was not observed.Freedom from any valve-related intervention was 95% at 8 years (95% confidence interval 91% to 99%). Conclusion-Midterm

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Section: Discussionmentioning

confidence: 73%

A Critical Reappraisal of the Ross Operation

et al. 2006

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“…Short term results with these techniques have been reported with promising results. 5 However, reinforcement techniques must not adversely affect geometry and compliance, and longer term results are awaited. The intra-aortic cylinder or subcoronary implantation techniques obviate concerns about diameter increase and may be a useful alternative, especially in dilated aortic roots, 3 although these techniques are technically demanding and freedom from reoperation may not be better.…”

Section: Discussionmentioning

confidence: 99%

Excessive pulmonary autograft dilatation causes important aortic regurgitation

Hokken

2003

Heart

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A ortic root replacement with reimplantation of the coronary arteries using the pulmonary autograft (PAG) is an accepted operative technique to treat aortic valve disease in children and adults. However, the technically demanding operative technique and lack of long term results regarding function of the PAG limit widespread use. The behaviour of the PAG in the systemic circulation raises concern because of the thinner wall of the pulmonary root and the lesser amount of collagen as compared to the aortic root.1 Severe PAG dilatation may result in aortic regurgitation (AR) and subsequent reoperation. We reviewed our first cohort of adult patients who underwent this operation. 2 METHODSFrom January 1989 until May 1995, 37 adult patients (20 male; mean age 29.1 years, range 19.3-52.1 years) underwent aortic root replacement using the PAG for aortic valve disease. The aetiology was bicuspid valve (n = 28), degenerative valve disease (n = 5), cured endocarditis (n = 3), and annuloaortic ectasia (n = 1). The haemodynamic diagnosis was aortic stenosis in 14 patients, regurgitation in 16 patients, and both in seven patients. Standard procedures were applied with regard to cardiopulmonary bypass techniques. The PAG was placed on the left ventricular outflow tract and annulus. The pulmonary root was replaced by an allograft. AR was scored from colour Doppler flow studies. PAG diameters were measured from the echocardiograms after cardiopulmonary bypass, at discharge, one year postoperatively, and the last transthoracic echocardiogram (TTE) available. Measurements were performed at the annulus at the level of the leaflet hinges, and the sinus of Valsalva at the largest anteroposterior diameter. This was done in the long axis plane from a two dimensional image during systole using the inner wall distance.

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“…Patients' preoperative characteristics as well as operative technique (subcoronary, SC; root replacement, Root) and presence (ϩR) or absence (ϪR) of R are summarized in Tables 1 and 2, respectively. Indications and contraindications for the Ross procedure have been described in detail elsewhere. 4,9,12 As R was regarded any additional procedure performed at the aortic annulus, sinotubular junction, or both. Usually, at the level of the annulus, a 4-mm wide strip of pericardium, Dacron, or a 2/0 GoreTex R suture was placed between donor and recipient tissues to stabilize or to prevent dilatation.…”

Section: Study Population and Operative Datamentioning

confidence: 99%

Autograft Reinforcement to Preserve Autograft Function After the Ross Procedure

Charitos

Hanke²,

Stierle³

et al. 2009

Circulation

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on behalf of the German-Dutch Ross Registry Background-Autograft reinforcement interventions (R) during the Ross procedure are intended to preserve autograft function and improve durability. The aim of this study is to evaluate this hypothesis. Methods and Results-1335 adult patients (mean age:43.5Ϯ12.0 years) underwent a Ross procedure (subcoronary, SC, nϭ637; root replacement, Root, nϭ698). 592 patients received R of the annulus, sinotubular junction, or both. Regular clinical and echocardiographic follow-up was performed (mean:6.09Ϯ3.97, range:0.01 to 19.2 years). Longitudinal assessment of autograft function with time was performed using multilevel modeling techniques. The Root without R (RootϪR) group was associated with a 6ϫ increased reoperation rate compared to Root with R (RootϩR), SC with R (SCϩR), and without R (SC-R; 12.9% versus 2.3% versus 2.5%.versus 2.6%, respectively; PϽ0.001). SC and Root groups had similar rate of aortic regurgitation (AR) development over time. RootϩR patients had no progression of AR, whereas RootϪR had 6 times higher AR development compared to RootϩR. In SC, R had no remarkable effect on the annual AR progression. The SC technique was associated with lower rates of autograft dilatation at all levels of the aortic root compared to the Root techniques. R did not influence autograft dilatation rates in the Root group. Conclusions-For the time period of the study surgical autograft stabilization techniques preserve autograft function and result in significantly lower reoperation rates. The nonreinforced Root was associated with significant adverse outcome. Therefore, surgical stabilization of the autograft is advisable to preserve long-term autograft function, especially in the Root Ross procedure. (Circulation. 2009;120[suppl 1]:S146-S154.)

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Technical evolution of the Ross operation: midterm results in 186 patients

Cited by 23 publications

References 13 publications

A Critical Reappraisal of the Ross Operation

A Critical Reappraisal of the Ross Operation

Excessive pulmonary autograft dilatation causes important aortic regurgitation

Autograft Reinforcement to Preserve Autograft Function After the Ross Procedure

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