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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)

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

Authors

Tracy R. Geoffrion MD Assistant Professor in the Surgery department at Medical College of Wisconsin
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