1
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Wenos CD, Herrmann JL, Timsina LR, Patel PM, Fehrenbacher JW, Brown JW. Perioperative and long-term outcomes of Ross versus mechanical aortic valve replacement. J Card Surg 2022; 37:2963-2971. [PMID: 35989510 PMCID: PMC9542516 DOI: 10.1111/jocs.16831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/24/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Background The ideal aortic valve replacement strategy in young‐ and middle‐aged adults remains up for debate. Clinical practice guidelines recommend mechanical prostheses for most patients less than 50 years of age undergoing aortic valve replacement. However, risks of major hemorrhage and thromboembolism associated with long‐term anticoagulation may make the pulmonary autograft technique, or Ross procedure, a preferred approach in select patients. Methods Data were retrospectively collected for patients 18–50 years of age who underwent either the Ross procedure or mechanical aortic valve replacement (mAVR) between January 2000 and December 2016 at a single institution. Propensity score matching was performed and yielded 32 well‐matched pairs from a total of 216 eligible patients. Results Demographic and preoperative characteristics were similar between the two groups. Median follow‐up was 7.3 and 6.9 years for Ross and mAVR, respectively. There were no early mortalities in either group and no statistically significant differences were observed with respect to perioperative outcomes or complications. Major hemorrhage and stroke events were significantly more frequent in the mAVR population (p < .01). Overall survival (p = .93), freedom from reintervention and valve dysfunction free survival (p = .91) were equivalent. Conclusions In this mid‐term propensity score‐matched analysis, the Ross procedure offers similar perioperative outcomes, freedom from reintervention or valve dysfunction as well as overall survival compared to traditional mAVR but without the morbidity associated with long‐term anticoagulation. At specialized centers with sufficient expertize, the Ross procedure should be strongly considered in select patients requiring aortic valve replacement.
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Affiliation(s)
- Chelsea D Wenos
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jeremy L Herrmann
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Divison of Pediatric Cardiothoracic Surgery, Riley Children's Health, Indiana University Health, Indianapolis, Indiana, USA
| | - Lava R Timsina
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Surgery, Indiana University School of Medicine, Center for Outcomes Research in Surgery, Indianapolis, Indiana, USA
| | - Parth M Patel
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John W Fehrenbacher
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Division of Cardiothoracic Surgery, Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA
| | - John W Brown
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Divison of Pediatric Cardiothoracic Surgery, Riley Children's Health, Indiana University Health, Indianapolis, Indiana, USA
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2
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Van den Eynde J, Sá MPBO, Callahan CP, Dimagli A, Vervoort D, Kampaktsis PN, Zhigalov K, Ruhparwar A, Weymann A. Right ventricular outflow tract reconstruction with Medtronic Freestyle valve in the Ross procedure: A systematic review with meta-analysis. Artif Organs 2020; 45:338-345. [PMID: 33001477 DOI: 10.1111/aor.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
Cryopreserved pulmonary homografts (PH) are the current gold standard for right ventricular outflow tract (RVOT) reconstruction in the Ross procedure. Unfortunately, their use is limited by a relatively scarce availability and high cost. Porcine stentless xenografts (SX) such as the Medtronic Freestyle SX are increasingly being used, although it is unclear whether the hemodynamic performance and the long-term durability are satisfactory. The present systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. The pooled treatment effects were calculated using a weighted DerSimonian-Laird random-effects model. We also evaluated the effect of time after RVOT reconstruction on valve gradients using meta-regression. Six studies with a total of 156 patients met the inclusion criteria. The pooled estimates for the pooled follow-up of 37 months were: 1.3% operative mortality, 94.8% overall survival, 7.5% structural valve deterioration, 5.2% reintervention, 73.3% asymptomatic, and 1.5% moderate or severe pulmonary insufficiency. Peak valve gradients were significantly correlated with time after RVOT, increasing during follow-up. Three studies compared PH with SX, one concluded that the SX is an acceptable alternative for RVOT reconstruction, whereas two concluded that this valvular substitute had inferior performance. The Freestyle SX can be considered as an alternative to PH, although it might be associated with more reinterventions, higher peak valve pressure gradients, and pulmonary valve dysfunction.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, University of Pernambuco, Recife, Brazil
| | - Connor P Callahan
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Arnaldo Dimagli
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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3
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Mazine A, Rocha RV, El-Hamamsy I, Ouzounian M, Yanagawa B, Bhatt DL, Verma S, Friedrich JO. Ross Procedure vs Mechanical Aortic Valve Replacement in Adults: A Systematic Review and Meta-analysis. JAMA Cardiol 2019; 3:978-987. [PMID: 30326489 DOI: 10.1001/jamacardio.2018.2946] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The ideal aortic valve substitute in young and middle-aged adults remains unknown. Objective To compare long-term outcomes between the Ross procedure and mechanical aortic valve replacement in adults. Data Sources The Ovid versions of MEDLINE and EMBASE classic (January 1, 1967, to April 26, 2018; search performed on April 27, 2018) were screened for relevant studies using the following text word search in the title or abstract: ("Ross" OR "autograft") AND ("aortic" OR "mechanical"). Study Selection All randomized clinical trials and observational studies comparing the Ross procedure to the use of mechanical prostheses in adults undergoing aortic valve replacement were included. Studies were included if they reported any of the prespecified primary or secondary outcomes. Studies were excluded if no clinical outcomes were reported or if data were published only as an abstract. Citations were screened in duplicate by 2 of the authors, and disagreements regarding inclusion were reconciled via consensus. Data Extraction and Synthesis This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. Data were independently abstracted by 3 reviewers and pooled using a random-effects model. Main Outcomes and Measures The prespecified primary outcome was all-cause mortality. Results The search identified 2919 reports, of which 18 studies (3516 patients) met inclusion criteria, including 1 randomized clinical trial and 17 observational studies, with a median average follow-up of 5.8 (interquartile range, 3.4-9.2) years. Analysis of the primary outcome showed a 46% lower all-cause mortality in patients undergoing the Ross procedure compared with mechanical aortic valve replacement (incidence rate ratio [IRR], 0.54; 95% CI, 0.35-0.82; P = .004; I2 = 28%). The Ross procedure was also associated with lower rates of stroke (IRR, 0.26; 95% CI, 0.09-0.80; P = .02; I2 = 8%) and major bleeding (IRR, 0.17; 95% CI, 0.07-0.40; P < .001; I2 = 0%) but higher rates of reintervention (IRR, 1.76; 95% CI, 1.16-2.65; P = .007; I2 = 0%). Conclusions and Relevance Data from primarily observational studies suggest that the Ross procedure is associated with lower all-cause mortality compared with mechanical aortic valve replacement. These findings highlight the need for a large, prospective randomized clinical trial comparing long-term outcomes between these 2 interventions.
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Affiliation(s)
- Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rodolfo V Rocha
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ismail El-Hamamsy
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Maral Ouzounian
- Department of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Department of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Subodh Verma
- Department of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jan O Friedrich
- Department of Critical Care Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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4
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Salehi M, Sattarzadeh R, Soleimani AA, Radmehr H, Mirhosseini J, Sanatkar Far M. The Ross Operation: Clinical Results and Echocardiographic Findings. Asian Cardiovasc Thorac Ann 2016; 15:30-4. [PMID: 17244919 DOI: 10.1177/021849230701500107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Between November 2001 and September 2004, 80 patients aged 11 to 56 years (mean, 27.6 years) underwent the Ross operation. The mean preoperative New York Heart Association functional class was 2.37 ± 0.72, and the mean ejection fraction was 52.8% ± 16%. Aortic involvement included stenosis in 19 (24%) patients, regurgitation in 22 (28%), and both in 39 (49%). Root replacement was the technique used in all cases. The mean hospital stay was 5 days, and 74 patients (93%) were followed up for 4–48 months. Four-year actuarial survival rate was 96.25%. Postoperative echocardiography revealed no pulmonary autograft insufficiency in 50 patients (63%), trivial to mild insufficiency in 22 (28%), moderate insufficiency in 2 (3%), and severe insufficiency in one (1%). Two patients required autograft re-intervention. Postoperative echocardiography of the pulmonary homograft valve showed severe stenosis (peak gradient > 50 mm Hg) in 2 patients, and moderate stenosis (peak gradient 25–50 mm Hg) in one. The mean postoperative left ventricular ejection fraction was 51.4%. The Ross operation can be considered an elegant alternative to prosthetic valves in the treatment of aortic valve diseases in developing countries.
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Affiliation(s)
- Mehrdad Salehi
- Department of Cardiac Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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5
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Said SM, Burkhart HM. When repair is not feasible: prosthesis selection in children and adults with congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17:22-9. [PMID: 24725713 DOI: 10.1053/j.pcsu.2014.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital heart surgeons face many challenges when dealing with valvular pathology in the pediatric population. Because of the concerns related to growth, repair should be the main goal. However, this is not always feasible and valve replacement becomes the only other alternative. Valve replacement also represents one of the most common procedures performed for adults with congenital heart disease, with several valve options existing including homografts, xenografts, autografts, and other artificial prostheses. The choice sometimes may be difficult because there are advantages and disadvantages to each valve substitute. In this article, we will address the different options of valve replacement in children and adults with congenital heart disease, and review the current literature that supports current practice.
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Affiliation(s)
- Sameh M Said
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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6
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Botha CA. The Ross operation: utilization of the patient’s own pulmonary valve as a replacement device for the diseased aortic valve. Expert Rev Cardiovasc Ther 2014; 3:1017-26. [PMID: 16292993 DOI: 10.1586/14779072.3.6.1017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prosthetic heart valves have been outpaced by progress in cardiac surgery. Early biologic valve prostheses consisted of tissues mounted on a rigid stent, and did not require anticoagulation, but rarely survived two decades. Subsequently, durable mechanical valve prostheses dominated despite, the requisite anticoagulation. The mechanical design remains imperfect, with obstruction to flow, turbulence, hematological changes and also, occasionally audible clicks. Reports documenting superior function for cryopreserved human aortic heart valves (homografts) without these problems, albeit with limited durability, followed. The marketing of 'stentless biologic valves', mimicking these attributes was a reaction to the shortage of homografts. These imperfections explain the rediscovery of the Ross operation, in which the patient's pulmonary valve (autograft) is excised to replace the aortic valve. The autograft is living tissue, complete with attributes of a healthy heart valve, including growth and durability. The pulmonary valve, where lower pressure and oxygen saturation retards degeneration, is substituted with a pulmonary homograft. The Ross operation is exacting and leaves the patient with two potentially malfunctioning valves.
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Affiliation(s)
- Cornelius A Botha
- Cardiac Clinic Bodensee (Lake Constance), Weinbergstrasse 1, Kreuzlingen, CH 8280, Switzerland.
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7
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Mitropoulos FA, Kanakis MA, Apostolopoulou SC, Rammos S, Anagnostopoulos CE. The Ross-Konno procedure as reoperative treatment in a young adult with congenital aortic stenosis. Heart Surg Forum 2012; 15:E182-4. [PMID: 22917820 DOI: 10.1532/hsf98.20111091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients. We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.
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Affiliation(s)
- Fotios A Mitropoulos
- Department of Pediatric Cardiac Surgery and Congenital Heart Surgery, Onassis Cardiac Center, Athens, Greece.
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8
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Uddin A, Thomson JDR, Plein S, Greenwood JP. Late dynamic right ventricular outflow obstruction after the Ross procedure for bicuspid aortic valve disease. Circulation 2012; 125:e1043-6. [PMID: 22733343 DOI: 10.1161/circulationaha.111.083212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, United Kingdom
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9
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Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure. Int J Obstet Anesth 2009; 18:387-91. [DOI: 10.1016/j.ijoa.2009.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 09/06/2008] [Accepted: 02/09/2009] [Indexed: 11/18/2022]
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10
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Cordovil A, Filho OC, De Andrade JL, Rodrigues ACT, Gerola LA, Moises V, Buffolo E, De Camargo Carvalho AC. Exercise Echocardiography in Cryopreserved Aortic Homografts: Comparison of a Prototype Stentless, a Stented Bioprosthesis, and Native Aortic Valves. Echocardiography 2009; 26:1204-10. [DOI: 10.1111/j.1540-8175.2009.00940.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Frigiola A, Ranucci M, Carlucci C, Giamberti A, Abella R, Di Donato M. The Ross Procedure in Adults: Long-Term Follow-Up and Echocardiographic Changes Leading to Pulmonary Autograft Reoperation. Ann Thorac Surg 2008; 86:482-9. [PMID: 18640320 DOI: 10.1016/j.athoracsur.2008.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 03/30/2008] [Accepted: 04/01/2008] [Indexed: 11/18/2022]
Affiliation(s)
- Alessandro Frigiola
- Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, Milan, Italy
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12
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Yuan SM, Mishaly D, Shinfeld A, Raanani E. Right ventricular outflow tract reconstruction: valved conduit of choice and clinical outcomes. J Cardiovasc Med (Hagerstown) 2008; 9:327-37. [DOI: 10.2459/jcm.0b013e32821626ce] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Jacquet L, Vancaenegem O, Rubay J, Laarbaui F, Goffinet C, Lovat R, Noirhomme P, El Khoury G. Intensive care outcome of adult patients operated on for congenital heart disease. Intensive Care Med 2006; 33:524-8. [PMID: 17177049 DOI: 10.1007/s00134-006-0462-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the ICU outcome and the most frequent complications observed in adult patients operated on for a congenital heart disease. DESIGN AND SETTING Retrospective analysis of prospectively collected data and chart review in an adult cardiovascular ICU of a university hospital. PATIENTS 156 patients older than 15 years with congenital heart disease undergoing cardiac surgery between June 2001 and June 2005. RESULTS According to the initial cardiac malformation, patients were divided in four groups with different operative risk based on the Euroscore: those diagnosed bicuspid aortic valve (n = 73) had a score of 5, those with tetralogy of Fallot (n = 33) 5.5, those with simple cardiac defect (n = 26) 3, and those with complex malformations (n = 24) 6. Only two patients (one with tetralogy of Fallot and one with complex malformations) died during the hospitalization (1.2%). CONCLUSION Euroscore clearly overestimates the risk of surgery in this population of adults with congenital heart disease. Mortality and morbidity were low in those diagnosed bicuspid aortic valve, tetralogy of Fallot, or simple cardiac defect, justifying early surgery for incipient complications. Patients with complex congenital defect require prolonged ICU stay, sometimes with mechanical cardiac support, but their overall good outcome justifies these efforts.
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Affiliation(s)
- Luc Jacquet
- Cardiovascular Intensive Care Unit, University Hospital Saint-Luc, 10 avenue Hippocrate, 1200, Brussels, Belgium.
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14
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Khwaja S, Nigro JJ, Starnes VA. The Ross procedure is an ideal aortic valve replacement operation for the teen patient. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:173-5. [PMID: 15818374 DOI: 10.1053/j.pcsu.2005.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The Ross procedure is an ideal aortic valve replacement for the teenage patient because the pulmonary autograft is durable, is nonthrombogenic, has excellent hemodynamics, and grows. Since 1992, our center has performed 194 Ross procedures, and 53 of these were in teenagers (10 to 21 years of age). In this group, there have been no perioperative deaths, hospital length of stay was 4 days, and re-operation for autograft failure was only 2% at mean follow-up of 69 months. All patients are in NYHA heart failure class I. Because of its proven efficacy, the Ross operation is our preferred aortic valve replacement for the teenage patient.
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Affiliation(s)
- Shamsuddin Khwaja
- Department of Cardiothoracic Surgery, University of Southern California, Childrens Hospital Los Angeles, 90027, USA
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Concha M, Aranda PJ, Casares J, Merino C, Alados P, Muñoz I, Gonzalez JR, Ribes R, Villalba R. The Ross Procedure. J Card Surg 2004; 19:401-9. [PMID: 15383050 DOI: 10.1111/j.0886-0440.2004.04080.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The search for the ideal substitute for the aortic valve led Donald Ross to develop the pulmonary autograft concept in 1967. A historical, technical, and scientific review of this surgical option is presented together with our clinical experience. MATERIALS AND METHODS The literature is reviewed to identify the advantages and pitfalls of the Ross procedure over the last decades. We also present our clinical experience with 92 patients operated between 1997 and May 2003. RESULTS Of the total, 70.65% (n = 65) were males, mean age was 29.32 +/- 11.9 years, with 20 patients under 16 and 6 patients under 10 years. Twenty-five patients (27.17%) had 31 previous interventions. There were 41 associated procedures in 34 patients. Perioperative mortality was 2.17% (two patients). Eight patients required reexploration for bleeding, one required an aortocoronary bypass, and one a permanent pacemaker. Follow-up was 97% with 2.71 patients/year (average 32.55 +/- 19.01 months). Two patients required autograft replacement, one suffered a 44-mm dilatation of the autograft, and one 13-year-old girl developed autograft endocarditis. Six patients suffered severe homograft stenosis (>50 mmHg), two were treated percutaneously, and one required replacement. Combined freedom from reintervention is 93.56 +/- 2.81% at 5 years. CONCLUSIONS The Ross procedure is a mature concept with thousands of patients operated worldwide and a cumulative experience of over 30 years. Although we believe that it is the procedure of choice in the pediatric population, women in child-bearing age, and substantial subgroups of adult patients, efforts must continue to minimize the incidence of auto- and homograft failure in the long term.
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Affiliation(s)
- Manuel Concha
- Cardiovascular Surgery Department, Hopsital Universitario Reina Sofia, Cordoba, Spain
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16
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Baker SS, O'Laughlin MP, Jollis JG, Harrison JK, Sanders SP, Li JS. Cost implications of closure of atrial septal defect. Catheter Cardiovasc Interv 2002; 55:83-7. [PMID: 11793500 DOI: 10.1002/ccd.10079] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We sought to evaluate the relative cost of surgical and device closure of atrial septal defect. Device closure for atrial septal defects is becoming an alternative to surgical closure. We examined the hospital-generated cost data in 13 patients who underwent surgical repair and 15 patients who underwent device closure of an atrial septal defects (ASD) or patent foramen ovale (PFO) during a prospective clinical trial of the device. The cost of device closure of ASD was 7,837 dollars less on average than surgical closure when the cost of the occlusion device was excluded (device closure cost 7,397 dollars +/- 2,822 dollars, surgical closure cost 15,234 dollars +/- 3,851 dollars; P < 0.001). When adjusted for a 5% failure rate of device closure, the cost savings was 7,076 dollars. Device closure of ASD results in substantial hospital-related cost savings that will be an important consideration once new devices are approved for clinical use.
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Affiliation(s)
- Sherri S Baker
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA
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17
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da Costa FD, da Costa MB, da Costa IA, Poffo R, Sardeto EA, Matte E. Clinical experience with heart valve homografts in Brazil. Artif Organs 2001; 25:895-900. [PMID: 11903143 DOI: 10.1046/j.1525-1594.2001.06902.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this paper is to describe the development and progress of the first heart valve homograft bank in Brazil as well as to report the 5-year clinical results. The bank was started in 1995 and employs modern techniques of cryopreservation. Organ procurement increased from 11 hearts in 1995 to 138 hearts in 2000. In the beginning of the experience, only 2 hospitals were using these valves, but this increased to 18 centers in 2000. Clinical experience at the major center includes 117 cases of the Ross procedure, 62 aortic homograft implantations, and 18 cases of mitral homografts. Five-year survival after the Ross procedure was 99.1%, and survival free from any kind of complication was 88.8%. No patients are on anticoagulants, and the incidence of thromboembolism was null. We conclude that auto- and homografts are probably the best alternative to aortic valve replacement for young patients in developing countries.
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Affiliation(s)
- F D da Costa
- Santa Casa de Misericórdia de Curitiba, Pontifícia Universidade Católica do Paraná, Brazil
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18
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Grunkemeier GL, Li HH, Naftel DC, Starr A, Rahimtoola SH. Long-term performance of heart valve prostheses. Curr Probl Cardiol 2000; 25:73-154. [PMID: 10709140 DOI: 10.1053/cd.2000.v25.a103682] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G L Grunkemeier
- Medical Data Research Center, Providence Health System, Portland, Oregon, USA
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19
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Abstract
During the 31 years since the initial Ross procedure, data have been collected that have been helpful in assessing long-term performance of the autograft. The ongoing study of the pulmonary autograft supports the use of the Ross procedure in young patients, in females of childbearing age, and in patients with congenital aortic stenosis and complex left ventricular outflow tract obstruction. We continue to see little or no thromboembolism despite no anticoagulation therapy. The remarkable ability of the autograft to grow in children is extremely beneficial. Additionally, excellent results have been obtained in some series for the treatment of endocarditis. Recently, the autograft has performed similarly to a normal aortic valve under high stress. Changes in implantation techniques transitioning from subcoronary to root replacement and performing annular narrowing has decreased the incidence of early regurgitation. A potential for an immune response with resulting pulmonary stenosis and possible early explanation of the pulmonary homograft exists; however, overall, results of the Ross procedure are excellent and highly reproducible.
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