The Choice of Pulmonary Autograft in Aortic Valve Surgery: A State-of-the-Art Primer

Nappi, Francesco; Singh, Sanjeet; Bellomo, Francesca; Nappi, Pierluigi; Iervolino, Adelaide; Acar, Christophe

doi:10.1155/2021/5547342

Cited by 3 publications

(5 citation statements)

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“…Although allogenic and autologous substitutes recorded similar hemodynamic performance with mean and peak transaortic gradients <10 mm Hg in the vast majority of individuals [ 97 ], pulmonary autografts revealed minimal calcification or degeneration, whereas many individuals develop high transaortic gradients following bioprosthesis or homograft implantation [ 103 , 104 , 105 , 106 , 107 ]. This implies that the transvalvular gradient remains stable over time with the use of the PAs as reported in long-term follow-ups, whereas it tends to increase after the implantation of homograft or bioprosthetic conduits [ 48 , 108 , 109 , 110 , 111 ].…”

Section: Resultsmentioning

confidence: 99%

“…The use of Dacron as an external reinforcement is a choice adopted by many surgeons, however, we never were in favor of adopting it. We preferred to maintain the characteristics of PAs as living tissue while trying to induce the remodeling of the pulmonary conduit [ 6 , 7 , 28 , 53 , 54 , 106 ].…”

Section: Remodeling Induced With the Use Of Polyester: Crosstalk Betw...mentioning

confidence: 99%

“…The bioresorbable polyester external prosthesis increased the surface of the neoaorta and, at the same time, was reabsorbed within the PA in order to modify both the cohesion forces and the elastic characteristics of the membrane. This process was possible for the molecular structure of PDS, which is characterized by the repetition of fundamental units, with a crystallinity of about 55%, capable of increasing the intramolecular cohesion forces [ 7 , 21 , 22 , 23 , 24 , 106 , 114 ] ( Figure 8 A,B).…”

Section: Remodeling Induced With the Use Of Polyester: Crosstalk Betw...mentioning

confidence: 99%

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Biomechanics of Pulmonary Autograft as Living Tissue: A Systematic Review

Nappi

Singh

2022

Bioengineering

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Introduction: The choice of valve substitute for aortic valve surgery is tailored to the patient with specific indications and contraindications to consider. The use of an autologous pulmonary artery (PA) with a simultaneous homograft in the pulmonary position is called a Ross procedure. It permits somatic growth and the avoidance of lifelong anticoagulation. Concerns remain on the functionality of a pulmonary autograft in the aortic position when exposed to systemic pressure. Methods: A literature review was performed incorporating the following databases: Pub Med (1996 to present), Ovid Medline (1958 to present), and Ovid Embase (1982 to present), which was run on 1 January 2022 with the following targeted words: biomechanics of pulmonary autograft, biomechanics of Ross operation, aortic valve replacement and pulmonary autograph, aortic valve replacement and Ross procedure. To address the issues with heterogeneity, studies involving the pediatric cohort were also analyzed separately. The outcomes measured were early- and late-graft failure alongside mortality. Results: a total of 8468 patients were included based on 40 studies (7796 in pediatric cohort and young adult series and 672 in pediatric series). There was considerable experience accumulated by various institutions around the world. Late rates of biomechanical failure and mortality were low and comparable to the general population. The biomechanical properties of the PA were superior to other valve substitutes. Mathematical and finite element analysis studies have shown the potential stress-shielding effects of the PA root. Conclusion: The Ross procedure has excellent durability and longevity in clinical and biomechanical studies. The use of external reinforcements such as semi-resorbable scaffolds may further extend their longevity.

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Section: Resultsmentioning

confidence: 99%

Section: Remodeling Induced With the Use Of Polyester: Crosstalk Betw...mentioning

confidence: 99%

Section: Remodeling Induced With the Use Of Polyester: Crosstalk Betw...mentioning

confidence: 99%

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Biomechanics of Pulmonary Autograft as Living Tissue: A Systematic Review

Nappi

Singh

2022

Bioengineering

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“…Therefore, the patient’s lifestyle, the need for long-term anticoagulants, and future reproductive plans in the case of female patients should be considered. A Ross procedure may represent the ideal option for special populations because it uses the pulmonary autograft, which constitutes a living tissue [ 111 , 126 , 127 , 128 , 129 , 130 ].…”

Section: Assessment and Treatmentmentioning

confidence: 99%

“…PA implanted in an aortic position offers a lasting solution, especially in pregnant women [ 123 , 130 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 ]. Patients who underwent the Ross operation disclosed a retrieval of normal life expectancy, reaching an excellent quality of life with a low number of valve-related complications [ 127 , 128 , 129 , 130 ]. The Ross procedure is particularly recommended for women who plan pregnancy because prolonged administration of anticoagulant drugs is not necessary [ 153 , 154 , 155 , 156 ].…”

Section: Assessment and Treatmentmentioning

confidence: 99%

Patients with Bicuspid Aortopathy and Aortic Dilatation

Nappi

Giacinto

Lusini

et al. 2022

JCM

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(1) Background: Bicuspid aortic valve (BAV) is the most frequent congenital cardiac disease. Alteration of ascending aorta diameter is a consequence of shear stress alterations due to haemodynamic abnormalities developed from inadequate valve cusp coaptation. (2) Objective: This narrative review aims to discuss anatomical, pathophysiological, genetical, ultrasound, and radiological aspects of BAV disease, focusing on BAV classification related to imaging patterns and flux models involved in the onset and developing vessel dilatation. (3) Methods: A comprehensive search strategy was implemented in PubMed from January to May 2022. English language articles were selected independently by two authors and screened according to the following criteria. (4) Key Contents and Findings: Ultrasound scan is the primary step in the diagnostic flowchart identifying structural and doppler patterns of the valve. Computed tomography determines aortic vessel dimensions according to the anatomo-pathology of the valve. Magnetic resonance identifies hemodynamic alterations. New classifications and surgical indications derive from these diagnostic features. Currently, indications correlate morphological results, dissection risk factors, and genetic alterations. Surgical options vary from aortic valve and aortic vessel substitution to aortic valve repair according to the morphology of the valve. In selected patients, transcatheter aortic valve replacement has an even more impact on the treatment choice. (5) Conclusions: Different imaging approaches are an essential part of BAV diagnosis. Morphological classifications influence the surgical outcome.

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The effectiveness and safety of pulmonary autograft as living tissue in Ross procedure: a systematic review

Nappi¹,

Iervolino²,

Singh³

2022

Transl Pediatr

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Background: Reports on effectiveness and safety after the implant of pulmonary autograft (PA) living tissue in Ross procedure, to treat both congenital and acquired disease of the aortic valve and left ventricular outflow tract (LVOT), show variable durability results. We undertake a quantitative systematic review of evidence on outcome after the Ross procedure with the aim to improve insight into outcome and potential determinants.Methods: A systematic search of reports published from October 1979 to January 2021 was conducted (PubMed, Ovid Medline, Ovid Embase and Cochrane library) reporting outcomes after the Ross procedure in patients with diseased aortic valve with or without LVOT. Inclusion criteria were observational studies reporting on mortality and/or morbidity after autograft aortic valve or root replacement, completeness of follow-up >90%, and study size n ≥30. Forty articles meeting the inclusion criteria were allocated to two categories: pediatric patient series and young adult patient series. Results were tabulated for a clearer presentation.Results: A total of 342 studies were evaluated of which forty studies were included in the final analysis as per the eligibility criteria. A total of 8,468 patients were included (7,796 in pediatric cohort and young adult series and 672 in pediatric series). Late mortality rates were remarkably low alongside similar age-matched mortality with the general population in young adults. There were differences in implantation techniques as regard the variability in stress and the somatic growth that recorded conflicting outcomes regarding the miniroot vs the subcoronary approach.Discussion: The adaptability of lung autograft to allow for both stress variability and somatic growth make it an ideal conduit for Ross's operation. The use of the miniroot technique over subcoronary implantation for better adaptability to withstand varying degrees of stress is perhaps more applicable to different patient subgroups.

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The Choice of Pulmonary Autograft in Aortic Valve Surgery: A State-of-the-Art Primer

Cited by 3 publications

References 105 publications

Biomechanics of Pulmonary Autograft as Living Tissue: A Systematic Review

Biomechanics of Pulmonary Autograft as Living Tissue: A Systematic Review

Patients with Bicuspid Aortopathy and Aortic Dilatation

The effectiveness and safety of pulmonary autograft as living tissue in Ross procedure: a systematic review

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