Faculty Collaboration Database

Late Pulmonary Autograft Dilation: Can We Make a Good Operation Great? The Supported Ross. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2024;27:47-51

Date

03/25/2024

Pubmed ID

38522872

DOI

10.1053/j.pcsu.2024.01.007

Scopus ID

2-s2.0-85186343593 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

The Ross procedure is an excellent option for aortic valve replacement resulting in outstanding hemodynamic performance and the ability to avoid systemic anticoagulation. The long-term durability of the autograft is generally good but concerns for later aortic root dilation with ensuing neoaortic insufficiency have prompted efforts to stabilize the autograft, root, sinuses and Sino-tubular junction in order to delay or entirely avoid late reinterventions on the neoaortic root. We have employed an inclusion technique, supporting the Auto-graft in a Terumo Gelweave™ Valsalva graft. We performed a retrospective study of all 129 patients undergoing the Ross procedure from 1992 to 2019 at Children's Wisconsin. Fifty-one underwent the supported Ross (SR) and 78 underwent unsupported Ross (UR). Structured clinical data was collected and echocardiograms were reviewed. Median follow-up was 4.9 years (up to 22.6 years) for UR patients and 3.6 years (up to 11.4 years) for SR patients. In order to provide a fair comparison, we sub -analyzed patients aged 10 to 18 years who underwent the Ross procedure, 16 who underwent the UR and 18 patients who underwent the SR. Change in aortic annulus diameter (P = 0.002), aortic sinus diameter (P = 0.001) change in left ventricular function (P = 0.039) and change in aortic insufficiency (P = 0.008) were all worse in UR. The SR is simple, reproducible, and predictable. It seems to prevent change in annulus diameter, sinus diameter and to reduce late neoaortic insufficiency. Longer follow-up with a larger group of patients is required to draw definitive conclusions.

Author List

Mitchell ME, Woods RK, Geoffrion TR, Sow M

Author

Michael Edward Mitchell MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Autografts
Child
Dilatation
Dilatation, Pathologic
Follow-Up Studies
Humans
Pulmonary Valve
Retrospective Studies
Transplantation, Autologous