Ross procedure with aortic root tailoring for aortic valve replacement in the pediatric population. Ann Thorac Surg 1997 Aug;64(2):482-6
Date
08/01/1997Pubmed ID
9262598DOI
10.1016/S0003-4975(97)00567-5Scopus ID
2-s2.0-0031201337 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
BACKGROUND: Aortic valve replacement with a pulmonary autograft (Ross procedure) is being applied more commonly in children. Although indications for this procedure have been expanded, the presence of a dilated aortic annulus has remained a relative contraindication. In this condition, the use of an undersized autograft in an enlarged aortic annulus may result in significant aortic regurgitation.
METHODS: Among 68 children and young adults undergoing the Ross procedure, 15 (age range, 8 to 24 years) with severe aortic regurgitation or stenosis and an aortic annulus diameter that was at least 2 mm larger than the pulmonary annulus had aortic root tailoring. In this group, the diameter of the aortic annulus measured 26.6 +/- 1.3 mm (mean +/- standard error of the mean), whereas that of the pulmonary annulus was 22 +/- 0.9 mm. The mean annular difference was 4.6 +/- 0.7 mm (range, 2 to 12 mm). The aortic annulus was reduced by excising a triangular wedge of tissue posteriorly from the aortic valve annulus at the level of the commissure between the left and noncoronary cusps extending into the anterior leaflet of the mitral valve. The edges were reapproximated over a calibrated dilator to adjust the final size of the aortic annulus to 2 mm smaller than that of the pulmonary autograft. Circumferential felt strips were not used in any patient.
RESULTS: All patients survived and morbidity was limited to one reoperation for bleeding. Doppler echocardiographic examination performed at discharge demonstrated that no patient had more than trace to 1+ aortic regurgitation and none had evidence of aortic stenosis. Over a mean follow-up period of 6.3 +/- 1.5 months (range, 1 to 16 months) there has been no late morbidity or mortality and no progression of aortic regurgitation.
CONCLUSIONS: Aortic root tailoring further extends the use of the Ross procedure to patients with excessive aortic annular dilation while maintaining the potential for growth, which is particularly important in the pediatric population.
Author List
Durham LA 3rd, desJardins SE, Mosca RS, Bove ELAuthor
Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aortic Valve
Aortic Valve Insufficiency
Aortic Valve Stenosis
Cardiac Surgical Procedures
Child
Female
Humans
Male
Pulmonary Valve
Transplantation, Autologous
