Faculty Collaboration Database

The Externally Supported Ross Operation: Early Outcomes and Intermediate Follow-Up. Ann Thorac Surg 2015 Aug;100(2):631-8

Date

07/05/2015

Pubmed ID

26141776

DOI

10.1016/j.athoracsur.2015.04.123

Scopus ID

2-s2.0-84938695226 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

BACKGROUND: The externally supported Ross (supported Ross), consisting of a Dacron (DuPont, Wilmington, DE) graft to support the neoaortic root, has been used in adolescent and adult patients to prevent neoaortic dilatation. Outcomes after the supported Ross technique were compared with the Ross procedure using the standard aortic root replacement technique (standard Ross).

METHODS: This was a retrospective analysis of 36 adolescent and young adult patients who underwent the Ross procedure between 1992 and 2013. The outcomes of supported Ross procedures in 26 patients were compared with the Ross procedure in 10 patients. End points included survival, neoaortic root dilatation, development of neoaortic regurgitation, and the need for reintervention.

RESULTS: The median age at operation was 14 years (range, 11 to 31 years), and indications for the operation were mixed lesions (47%), followed by aortic regurgitation (42%) and stenosis (11%). There were no early deaths. The mean follow-up was 2.2 years (range, 1 to 11 years). At the 1-year (p = 0.01) and 3-year (p < 0.05) follow-up, patients in the supported Ross cohort had a smaller neoaortic root z-score. Neither cohort had a large number of patients with significant neoaortic regurgitation, with 1 patient in the supported cohort compared with 3 patients in the standard cohort. Overall, 4 patients (40%) in the standard Ross cohort had required reintervention, including 3 directed at the neoaortic root. One patient in the supported Ross cohort required early reintervention for revision of the right coronary artery.

CONCLUSIONS: At intermediate follow-up, patients who underwent the supported Ross technique were less likely to have neoaortic root dilatation compared with patients who underwent a standard Ross procedure. Further studies are needed to evaluate the long-term durability of this technique, particularly in regards to the development of significant aortic regurgitation, the rate of reintervention, and application to younger and smaller patients.

Author List

Jacobsen RM, Earing MG, Hill GD, Barnes M, Mitchell ME, Woods RK, Tweddell JS

Authors

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

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

Adolescent
Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Cardiac Surgical Procedures
Dilatation, Pathologic
Female
Follow-Up Studies
Heart Valve Diseases
Heart Valve Prosthesis
Humans
Male
Prosthesis Design
Pulmonary Valve
Retrospective Studies
Time Factors
Treatment Outcome
Vascular Grafting
Young Adult