*****AMERICAN JOURNAL OF CLINICAL NUTRITION*****
(REFERENCE 1 OF 20) 87267395
Sehring DA Continuing physician education: the Ross Conference approach.
In: Am J Clin Nutr (1987 Jul) 46(1 Suppl):192-7
ISSN: 0002-9165
The Ross Conferences on pediatric research are a series designed to assist in the correlation of findings from recent research on subjects pertaining to pediatrics with clinical practice and to stimulate further research by the exchange of information. Reports of the proceedings are published and distributed worldwide to pediatricians and other physicians in order to disseminate information at the leading edge of pediatric medicine.
*****AMERICAN JOURNAL OF CARDIOLOGY*****
(REFERENCE 2 OF 20) 99204684
Tantengco MV Humes RA Clapp SK Lobdell KW Walters HL 3rd Hakimi M Epstein ML Aortic root dilation after the Ross procedure.
In: Am J Cardiol (1999 Mar 15) 83(6):915-20
ISSN: 0002-9149
This study evaluated changes in neoaortic root geometry in patients who underwent the Ross procedure. Serial postoperative echocardiographic measurements of the neoaortic root indexed to the square root of body surface area (centimeters divided by meters) were obtained from 30 patients (age range 3.1 to 31.4 years) and compared with paired preoperative and immediate postoperative values. Normal aortic root diameter Z scores were derived from root dimensions obtained from 217 healthy controls. Compared with preoperative values, an immediate stretch of the neoaortic versus pulmonary root (annulus and sinuses of valsalva) was observed at a mean follow-up period of 1 week. Additional aortic annular dilation from baseline prehospital discharge values was observed at 2 to 12 months (baseline vs follow-up annulus Z score: 1.4 vs 2.6, p <0.01, n = 16) and at 16 to 33 months follow-up (0.8 vs 2.0, p <0.05, n = 12). In a similar fashion, there was additional enlargement of the aortic sinus from its stretched state at hospital discharge at 2 to 12 months (baseline vs follow-up sinus Z score: 2.0 vs 3.3, p <0.01, n = 17) and at 16 to 33 months (1.7 vs 3.0, p <0.01, n = 13). There were no differences in root size between 2 to 12 and 16 to 33 months after surgery. There was a decrease in left ventricular size with no alteration in blood pressure or degree of aortic valve regurgitation. Thus, aortic root dilation occurs up to the first year after the Ross procedure but does not appear to progress beyond this time.
Institutional address: Department of Pediatrics Wayne State University School of Medicine Children's Hospital of Michigan Detroit 48201 USA.
*****ANNALS OF THORACIC SURGERY*****
(REFERENCE 3 OF 20) 92061304
Hopkins RA St. Louis J Corcoran PC Ross' first homograft replacement of the aortic valve.
In: Ann Thorac Surg (1991 Nov) 52(5):1190-3
ISSN: 0003-4975
Ross' first homograft replacement of the aortic valve was reported in 1962. The homograft has been in continuous use around the world ever since. Much has been learned about how to handle homografts, both before and during their implantation. Homografts have special advantages, which make them an appropriate choice in a number of settings. This first successful case by Donald Ross set the stage for the growth in homograft valve use and the subsequent development of many ways of using allograft cardiovascular tissue for optimal cardiac reconstructions.
Institutional address: Department of Surgery Georgetown University Medical Center Washington DC 20007-2197.
(REFERENCE 4 OF 20) 99230060
Roughneen PT DeLeon SY Eidem BW Thomas NJ Cetta F Vitullo DA Magliato KE Berry TE Bakhos M Semilunar valve switch procedure: autotransplantation of the native aortic valve to the pulmonary position in the Ross procedure.
In: Ann Thorac Surg (1999 Mar) 67(3):745-50
ISSN: 0003-4975
BACKGROUND: The Ross procedure has gained wide acceptance in young patients with aortic valve disease. The durability of the pulmonary autograft in the aortic position has been proved, with up to 24 years of follow-up. The homograft pulmonary valve, however, has limited longevity. To circumvent this problem we harvested, repaired, and reimplanted the native aortic valve with intact commissures in the pulmonary position in 13 patients undergoing the Ross procedure for aortic insufficiency. METHODS: The cause of aortic insufficiency was rheumatic in 6 patients, congenital in 4, post-aortic valvotomy in 2, and bacterial endocarditis in 1. Patient age ranged from 5 to 45 years (mean, 17+/-9 years). Root replacement technique with coronary artery reimplantation was used. In the first 4 patients, the native aortic valve was sutured into the right ventricular outflow tract, and a polytetrafluorethylene patch was used to reconstruct the main pulmonary artery. In the last 9 patients, the aortic valve and polytetrafluorethylene patch were made into a conduit by another surgeon while the left-sided reconstruction was performed. RESULTS: All patients had marked reduction of left ventricular dilation and good function of the reimplanted native aortic valve, with up to 50 months of follow-up (mean, 29.9+/-14.2 months; range, 12 to 50 months). Two patients died 15 and 26 days, respectively, of a false
aneurysm rupture at the distal aortic anastomosis. In the remaining 11 patients, 9 (82%) had mild or absent, and 2 (18%) had mild to moderate, neoaortic valve regurgitation. Similarly, 9 patients (82%) had mild or absent, and 2 (18%) had mild to moderate, neopulmonary valve regurgitation. Mild neopulmonary valve stenosis was present in 6 patients (54%) (mean gradient, 29+/-4 mm Hg; range, 25 to 35 mm Hg). All surviving patients are in functional New York Heart Association functional class I. CONCLUSIONS: We conclude that use of the native aortic valve with the Ross procedure makes the procedure attractive and potentially curative. The diseased aortic valve works well in the pulmonary position because of lower pressure and resistance. The valve leaflets should remain viable and grow in both the pulmonary and aortic positions because they derive nutrition directly from the blood.
Institutional address: Department of Thoracic and Cardiovascular Surgery Loyola University Medical School Stritch School of Medicine Maywood Illinois 60153 USA.
(REFERENCE 5 OF 20) 99211552
Takkenberg JJ Zondervan PE van Herwerden LA Progressive pulmonary autograft root dilatation and failure after Ross procedure.
In: Ann Thorac Surg (1999 Feb) 67(2):551-3; discussion 553-4
ISSN: 0003-4975
We present a case of progressive pulmonary autograft root dilatation and subsequent failure after a Ross procedure. The explanted autograft vessel wall revealed striking histologic findings indicative of chronic media rupture. Examination of another explanted pulmonary autograft root showed similar histologic changes, suggesting a common phenomenon in pulmonary autograft roots. It may be the cause of progressive root dilatation as observed after Ross operations.
Institutional address: Department of Cardio-pulmonary Surgery Heart Center Dijkzigt Hospital and Erasmus University Rotterdam The Netherlands. Takkenberg@thch.azr.nl
(REFERENCE 6 OF 20) 99127632
Jones TK Lupinetti FM Comparison of Ross procedures and aortic valve allografts in children.
In: Ann Thorac Surg (1998 Dec) 66(6 Suppl):S170-3
ISSN: 0003-4975
BACKGROUND: The Ross procedure is useful, but at times an allograft valve is the only alternative to a mechanical aortic prosthesis. Since 1994 the Ross procedure or aortic allograft replacement has been used exclusively for aortic valve replacement at our institution. METHODS: Demographic, clinical, and echocardiographic data of 23 consecutive Ross and 8 allograft patients were compared. RESULTS: Groups were similar in age and weight. The Ross group had fewer prior operations. There were no deaths or major complications in either group. The Ross group had no late complications of the autograft but 1 reoperation for pulmonary allograft stenosis. In the allograft group there was one reoperation for allograft
insufficiency. Echocardiography was performed 2 to 11 days (mean, 4.3 days) after operation and 1 to 28 months (mean, 10.2 months) later. In the Ross group left ventricular wall thickness (mm) decreased from 11.0 +/- 2.3 to 7.8+/-1.7 (p < 0.0001), and left ventricular outflow tract maximal systolic velocity (m/sec) decreased from 1.9 +/-0.6 to 1.4+/-0.4 (p = 0.0001). In the allograft group left ventricular wall thickness (mm) decreased from 10.5 +/-2.6 to 9.0+/-2.6 (not
significant), and left ventricular outflow tract maximal systolic velocity (m/sec) increased from 1.5+/-0.9 to 1.9+/-0.7 (not significant). CONCLUSIONS: The Ross procedure results in significant improvement in left ventricular wall thickness and outflow tract
velocity not seen in allograft aortic valve replacements. The Ross procedure remains the preferred operation for children requiring aortic valve replacement.
Institutional address: Department of Pediatrics Children's Hospital and Medical Center University of Washington School of Medicine Seattle USA. tkjones@u.washington.edu
(REFERENCE 7 OF 20) 99127630
Oury JH Hiro SP Maxwell JM Lamberti JJ Duran CM The Ross Procedure: current registry results.
In: Ann Thorac Surg (1998 Dec) 66(6 Suppl):S162-5
ISSN: 0003-4975
BACKGROUND: The pulmonary autograft procedure for the treatment of aortic valve disease was developed and performed by Ross in 1967. The results he published in 1987 prompted increasing interest in the procedure. The International Registry of the Ross Procedure was established in 1993 to further examine longitudinal clinical outcomes. METHODS: The results from the Ross registry document the continued and growing interest in the procedure with 2,523 patients currently enrolled, representing 122 centers and 166 surgeons worldwide. RESULTS: Mortality (1987 to present) reported in the registry is 2.5%. It should be noted that follow-up stands at 70%. The most important issues for the registry to track are the incidence of reoperation for autograft failure and the fate of the pulmonary homograft. Reoperation for all valve-related problems is low (5.4%), with an autograft explant rate of 1.9%. Overall registry data indicate that the right ventricular outflow tract revision rate is 2.8%, with this decreasing by half to 1.3% in the 1987 to present subgroup. CONCLUSIONS: Rigorous analysis of outcomes is difficult with registry follow-up currently at 70%; however, the general conclusions derived from the registry are supported by other individual series with excellent follow-up. Success of the registry depends on judicious efforts by all participating surgeons and coordinators in documenting long-term patient results and reporting them to the registry.
Institutional address: The International Heart Institute of Montana Foundation Missoula 59808 USA. oury@sph.hbocvan.com
(REFERENCE 8 OF 20) 99015456
Bockoven JR Wernovsky G Vetter VL Wieand TS Spray TL Rhodes LA Perioperative conduction and rhythm disturbances after the Ross procedure in young patients.
In: Ann Thorac Surg (1998 Oct) 66(4):1383-8
ISSN: 0003-4975
BACKGROUND: The Ross procedure is performed for a variety of left ventricular outflow tract diseases in children. The preoperative hemodynamic burden of pressure or volume overload and associated ventricular hypertrophy can predispose to ventricular arrhythmias. Additional procedures performed with the Ross procedure (eg, Konno) may damage the conduction system. METHODS: Between January 1995 and February 1997, the Ross procedure was performed in 42 patients, 31 (74%) of whom had 71 prior interventions. Concomitant procedures (n = 42 in 23 patients) included 17 annular-enlarging procedures. Screening was performed for perioperative conduction and rhythm abnormalities. RESULTS: There was one postoperative death. Perioperative ventricular tachycardia occurred in 12 patients (29%), with 2 receiving antiarrhythmic medication for ventricular tachycardia at discharge. Transient complete heart block occurred in 3 patients, all of whom had concomitant procedures performed in the subaortic area; all patients were discharged in sinus rhythm and no patient received a permanent pacemaker. CONCLUSIONS: The Ross procedure can be performed successfully in children with complex cardiac disease with low mortality and perioperative morbidity. The incidence of perioperative ventricular tachycardia is high (29%), suggesting the need for vigilant perioperative monitoring and long- term surveillance.
Institutional address: The Children's Hospital of Philadelphia and Department of Pediatrics University of Pennsylvania School of Medicine 19104 USA.
(REFERENCE 9 OF 20) 95209417
DeLeon SY Quinones JA Miles RH Hofstra J Bell TJ Fisher EA Pifarre R Use of the native aortic valve as the pulmonary valve in the Ross procedure.
In: Ann Thorac Surg (1995 Apr) 59(4):1007-10
ISSN: 0003-4975
The placement of a foreign valve in the pulmonary position using the Ross procedure requires reoperation. To circumvent this problem, we devised a method of reimplanting the native aortic valve in the pulmonary position, and successfully performed this procedure in a 12- year-old diabetic boy operated on for the treatment of aortic insufficiency. Although diseased, the reimplanted aortic valve functioned well, with trivial stenosis and insufficiency. This modification offers patients with aortic valve disease a potentially curative operation.
Institutional address: Department of Thoracic-Cardiovascular Surgery Loyola University Medical Center Maywood Illinois 60153.
(REFERENCE 10 OF 20) 98391218
Morishita K Abe T Fukada J Sato H Shiiku C Alternative to reconstruction of the pulmonary outflow tract in the Ross procedure.
In: Ann Thorac Surg (1998 Aug) 66(2):549-50
ISSN: 0003-4975
We report our experience with 2 cases in which we used the native ascending aorta and a porcine valve to reconstruct the right ventricular outflow tract in the Ross procedure. Unfortunately, in many parts of the world, the lack of homografts for reconstruction of the right ventricular outflow tract limits the use of the Ross procedure. The technique described herein can be an alternative to a cryopreserved pulmonary homograft replacement for adult patients.
Institutional address: Department of Thoracic and Cardiovascular Surgery Sapporo Medical University School of Medicine Hokkaido Japan.
(REFERENCE 11 OF 20) 98309272
Jaggers J Harrison JK Bashore TM Davis RD Glower DD Ungerleider RM The Ross procedure: shorter hospital stay, decreased morbidity, and cost effective.
In: Ann Thorac Surg (1998 Jun) 65(6):1553-7; discussion 1557-8
ISSN: 0003-4975
BACKGROUND: The Ross procedure has become an accepted and sometimes preferred alternative to mechanical aortic valve replacement. One criticism of the Ross procedure is that it may have a higher operative mortality, morbidity, and cost. Several groups have shown that this operation can be performed safely with less than 3% mortality. The issue of higher cost has not been resolved. In this retrospective study we compared a consecutive group of patients undergoing the Ross procedure with an age- and disease-matched group of patients who underwent mechanical aortic valve replacement. METHODS: From 1993 to 1996, 22 consecutive adult patients (age range, 20 to 57 years; mean, 38 +/- 14 years) underwent the Ross procedure. Twenty-seven patients (age range, 17 to 57 years; mean, 41 +/- 10 years) underwent mechanical aortic valve replacement between 1991 and 1996. The hospital cost (in 1996 dollars) and postoperative length of stay were calculated for each patient using Transition I, a hospital- wide cost accounting system. RESULTS: There was no hospital mortality in either group. The incidence of significant valve-related complication was 5% (1/22 patients) in the Ross procedure group and 22% (6/27 patients) in the mechanical valve group. There were two late deaths in the group with mechanical aortic valve replacement. The length of stay for the Ross procedure group was 5.9 +/- 2.1 days, versus 8 +/- 1.85 days for the mechanical valve group (p < 0.01). The mean hospital costs were not significantly different, $23,140 +/- $7,825 for the mechanical valve group and $23,226 +/- $6,960 for the group having the Ross procedure. CONCLUSIONS: The data from this review demonstrate that the Ross procedure can be done safely, with short hospital stays, decreased morbidity, and costs comparable with those of standard mechanical aortic valve replacement in patients with isolated aortic valve disease.
Institutional address: Department of Surgery Duke University Medical Center Durham North Carolina USA. Jagge003@mc.duke.edu
(REFERENCE 12 OF 20) 98257244
Prat A Fabre OH Vincentelli A Doisy V Shaaban G Ross operation and mitral homograft for aortic and tricuspid valve endocarditis.
In: Ann Thorac Surg (1998 May) 65(5):1450-2
ISSN: 0003-4975
We report here a case of concomitant aortic and tricuspid valve endocarditis occurring in a 26-year-old woman 2 weeks after she had given birth by cesarean delivery. Preoperative transthoracic echocardiography revealed a previously undetected aorta-right atrium fistula, which at operation appeared to be congenital in origin. Surgical treatment consisted of aortic valve replacement with a pulmonary autograft, tricuspid valve replacement with a cryopreserved mitral homograft, and closure of the fistulous communication. The postoperative recovery was uneventful.
Institutional address: Service de Chirurgie Cardiaque Hopital Cardiologique Centre Hospitalier Regional Lille France. aprat@chru-lille.fr
(REFERENCE 13 OF 20) 98143795
Elkins RC Knott-Craig CJ Ward KE Lane MM The Ross operation in children: 10-year experience.
In: Ann Thorac Surg (1998 Feb) 65(2):496-502
ISSN: 0003-4975
BACKGROUND: The Ross operation, first performed in children in 1968, may be the ideal aortic valve replacement. Technical demands of the operation and two valves at risk have delayed acceptance. A review of our experience to assess midterm and long-term results with the Ross operation is presented. METHODS: The records of 150 consecutive patients, aged 7 days to 21 years (median age, 12 years, 75% less than 15 years) were reviewed. Follow-up was complete within the last 12 months (median, 2.8 years; range, 1 month to 10 years). Echocardiographic assessment was available on 116 (71%) within 1 year of closure and in 136 (91%) within 2 years. RESULTS: Survival was 97.3% at 8 years. Late autograft valve dysfunction required replacement in 2 and reoperation with restitution of autograft function in 6. Freedom from reoperation for autograft dysfunction is 90% +/- 4% at 8 years. Freedom from reoperation for homograft obstruction is 94% +/- 3% at 8 years. Pulmonary homograft dysfunction (gradient > 40 mm Hg) was present in 4 additional patients. Freedom
from reoperation on the homograft or a gradient of 40 mm Hg is 89% +/- 4% at 8 years. All patients have a normal, active lifestyle, without anticoagulants for their aortic valve replacement. CONCLUSIONS: The Ross operation is the preferred operative replacement in children requiring aortic valve replacement.
Institutional address: Section of Thoracic Surgery University of Oklahoma Health Sciences Center Oklahoma City 73190 USA.
(REFERENCE 14 OF 20) 96111925
Reddy VM Rajasinghe HA McElhinney DB van Son JA Black MD Silverman NH Hanley FL Extending the limits of the Ross procedure.
In: Ann Thorac Surg (1995 Dec) 60(6 Suppl):S600-3
ISSN: 0003-4975
BACKGROUND. The potential for growth and the proven long-term durability of the native pulmonary valve make it ideal for replacement of the diseased aortic valve, especially in growing children. The use of the autologous pulmonary valve can be further extended to patients with complex left ventricular outflow tract obstruction and to neonates and infants. METHODS. Between June 1993 and May 1995, 35 patients underwent the Ross procedure at our center. Of these, 15 (43%) had complex left ventricular outflow tract obstruction and 7 (20%) were infants, including 3 neonates. The autologous pulmonary valve was implanted as a root replacement with coronary reimplantation in all patients. Additional left ventricular outflow tract procedures performed were ventricular myectomy in 7 patients and a Konno type aortoventriculoplasty in 11 patients. RESULTS. There was one early death in a patient with borderline hypoplastic left heart syndrome. At a median follow-up of 9 months (range, 0.2 to 22 months) there were no late deaths or reinterventions. The autologous pulmonary valve function was excellent, with 1 (2.8%) patient having moderate insufficiency. CONCLUSIONS. Autologous pulmonary valve is an excellent option for aortic valve replacement in all age groups. Its use can be readily extended to neonates, infants, and patients with complex left ventricular obstruction requiring additional left ventricular outflow tract procedures.
Institutional address: Division of Cardiothoracic Surgery University of California San Francisco 94143-0118 USA.
(REFERENCE 15 OF 20) 93037810
Gunning AJ Ross' first homograft replacement of the aortic valve [letter]
In: Ann Thorac Surg (1992 Oct) 54(4):809-10
ISSN: 0003-4975
[No Abstract Available]
*****HEART*****
(REFERENCE 16 OF 20) 97100028
Runciman M Ostman-Smith I Westaby S Infant Ross procedure for recurrent aortic stenosis.
In: Heart (1996 Nov) 76(5):449-50
ISSN: 1355-6037
A male infant underwent an open aortic valvotomy during the second day of life. Aortic stenosis recurred and at the age of eight weeks he underwent a pulmonary autograft aortic root replacement (Ross procedure). The pulmonary autograft procedure is a valuable option in this circumstance.
Institutional address: Department of Paediatric Cardiology John Radcliffe Hospital Oxford.
*****JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY*****
(REFERENCE 17 OF 20) 97067991
David TE Omran A Webb G Rakowski H Armstrong S Sun Z Geometric mismatch of the aortic and pulmonary roots causes aortic insufficiency after the Ross procedure.
In: J Thorac Cardiovasc Surg (1996 Nov) 112(5):1231-7; discussion 1237-9
ISSN: 0022-5223
BACKGROUND: Geometric mismatch between the two semilunar valves can cause aortic insufficiency after the Ross procedure. Thus, whenever the aortic root is larger than the pulmonary root, surgical reduction of the aortic anulus or of the sinotubular junction (or both) to match the diameters of the pulmonary root is necessary to prevent late malfunction of the pulmonary autograft. METHODS: The Ross procedure was performed in 81 patients during the past 5 years. The diameters of the aortic and pulmonary roots were measured in 77 patients. Reduction of the aortic anulus and of the sinotubular junction was necessary in 27 patients, reduction of the aortic anulus alone in 12, and reduction of the sinotubular junction alone in 10. The pulmonary autograft was implanted in the subcoronary position in the aortic root in two patients, as a complete root replacement in 58, and as an inclusion root in 21. RESULTS: There was one operative death, caused by myocardial infarction. Aortic insufficiency developed in one patient who did not have measurement and reduction of the aortic anulus, and aortic root replacement was necessary 2 weeks later. Patients have been followed up from 2 to 64 months (mean 15 months). Two patients have required late reoperations: one because of pulmonary artery stenosis and the other because of a false aneurysm between the autograft and the mitral valve. The most recent Doppler echocardiographic study shows that 90% of the patients have only trace or no aortic insufficiency, and 10% have mild aortic insufficiency. CONCLUSION: This experience suggests that adjustment of the diameter of the aortic anulus or of the sinotubular junction of the aorta may be important to prevent aortic insufficiency after the Ross procedure.
Institutional address: Division of Cardiovascular Surgery Toronto Hospital Ontario Canada.
(REFERENCE 18 OF 20) 98290630
Reddy VM McElhinney DB Phoon CK Brook MM Hanley FL Geometric mismatch of pulmonary and aortic anuli in children undergoing the Ross procedure: implications for surgical management and autograft valve function.
In: J Thorac Cardiovasc Surg (1998 Jun) 115(6):1255-62; discussion 1262-3
ISSN: 0022-5223
BACKGROUND: There is often substantial mismatch between the diameters of the pulmonary and aortic anuli in young patients with systemic outflow tract disease. To implant the autologous pulmonary valve in the aortic position under such circumstances, it is necessary to adapt the geometry of the systemic outflow tract. The effects of such adaptations on autograft function in children are not well known. METHODS: To determine factors predictive of autograft regurgitation, we analyzed 41 cases of children who have undergone the Ross procedure. The diameter of the pulmonary valve was greater (by at least 3 mm) than that of the aortic valve in 20 cases, equal (within 2 mm) in 12 cases, and less (by at least 3 mm) in nine cases, with differences ranging from +10 to -12 mm. In 12 patients with a larger pulmonary anulus, aortoventriculoplasty was used to correct the mismatch. In patients with a larger aortic anulus, the mismatch was corrected by gradual adjustment along the circumference of the autograft, rather than by tailoring of the native aortic anulus. RESULTS: At follow-up (median 31 months), two patients had undergone reoperation on the neoaortic valve for moderate regurgitation. In the remaining 38 cases, autograft regurgitation was as follows: none or trivial in 30, mild in seven, and moderate in one. There was no correlation between regurgitation and age, geometric mismatch, or previous or concurrent procedures. CONCLUSIONS: Subtle technical factors that may result in distortion of the valve complex are probably more important determinants of autograft regurgitation than are indication for repair, geometric mismatch, or previous or concomitant outflow tract procedures. Significant mismatch of the semilunar anuli is not a contraindication to the Ross procedure in children.
Institutional address: Division of Cardiothoracic Surgery University of California San Francisco USA.
(REFERENCE 19 OF 20) 98266115
Stelzer P Weinrauch S Tranbaugh RF Ten years of experience with the modified Ross procedure.
In: J Thorac Cardiovasc Surg (1998 May) 115(5):1091-100
ISSN: 0022-5223
BACKGROUND: To assess the full root modification of the Ross procedure, we examined operative and long-term results. METHODS: We retrospectively reviewed 145 patients (118 men and 27 women) operated on from March 1987 through April 1997. Ages ranged from 17 to 68 years. Primary diagnosis was aortic stenosis in 43 patients (29.6%) and aortic regurgitation in 62 patients (42.8%). There was mixed disease (stenosis and regurgitation) in 40 patients (29.6%) of whom the vast majority had predominant stenosis. RESULTS: Early death was 7 of 145 patients (4.8%). Twelve patients had 14 significant complications (8.5%). There were four late deaths. Overall patient survival is 90.5% +/- 3.1% at 5 years and 84.5% +/- 14.1% at 7 years. Endocarditis occurred in three patients-two on the autograft and one on the pulmonary homograft. Three patients had cerebrovascular accidents. In 5 of 132 patients (3.8%) reoperations were required on the autograft. Freedom from autograft reoperation was 93.9% +/- 3.1% at 5 years and 88.6% +/- 6.4% at 7 years. Echocardiographic follow-up reveals more than mild aortic regurgitation in only nine patients, including the five patients in whom reoperations were required. Seven of 11 patients with active endocarditis at the time of the operation had adverse outcomes. CONCLUSIONS: Ten years' experience with the modified Ross procedure has shown excellent results with regard to short- and long-term morbidity and death. It is the procedure of choice for young patients who need aortic valve replacement but should be used with caution in the setting of active endocarditis.
Institutional address: Division of Cardiac Surgery Beth Israel Medical Center New York City NY 10003 USA.
(REFERENCE 20 OF 20) 96142252
Reddy VM Rajasinghe HA Teitel DF Haas GS Hanley FL Aortoventriculoplasty with the pulmonary autograft: the "Ross-Konno" procedure.
In: J Thorac Cardiovasc Surg (1996 Jan) 111(1):158-65; discussion 165-7
ISSN: 0022-5223
BACKGROUND: For patients with complex left ventricular outflow tract obstruction, including hypoplastic aortic anulus with or without severe diffuse subaortic stenosis, various aortoventriculoplasty procedures (e.g., Konno procedure and its modifications; extended aortic allograft root replacement) are important management options. In younger patients, however, reoperation for valve replacement is inevitably required, and anticoagulation issues pose additional problems. The pulmonary autograft provides a promising option for aortic valve replacement as part of the aortoventriculoplasty procedure in children. Long-term follow up shows that the pulmonary autograft functions well as the systemic arterial (neoaortic) valve and that valve growth occurs. METHODS: Between July 1993 and May 1995, 11 patients 4 days to 17 years old (median 12 months) underwent aortoventriculoplasty with pulmonary autograft (Ross-Konno procedure). The diagnoses were aortic stenosis with or without subaortic stenosis (n = 8), Shone complex (n = 2), and interrupted aortic arch with subaortic stenosis (n = 1). On average, 1.9 previous interventions had been performed per patient, including a previous Konno procedure in one patient. The aortic root was replaced with a pulmonary autograft valve. The left ventricular outflow tract was enlarged with a Dacron polyester fabric patch in two patients, with an allograft aortic patch in two patients and a right ventricular infundibular free wall muscular extension harvested in continuity with the autograft in seven patients. RESULTS: Intraoperative transesophageal echocardiographic assessment revealed mild aortic insufficiency in one patient. One patient had a residual left ventricular outflow tract gradient of 15 mm Hg. Significant complications were cardiac tamponade from bleeding (n = 1) and complete heart block necessitating a permanent pacemaker (n = 1). Follow-up ranged from 2 weeks to 16 months. To date, there have been no late deaths or reoperations. Follow-up echocardiography revealed mild autograft insufficiency in one patient and a 16 mm Hg residual left ventricular outflow tract gradient in one patient. CONCLUSIONS: Initial experience suggests that aortoventriculoplasty with the pulmonary autograft is an excellent alternative for young patients with complex left ventricular outflow tract obstruction. Because the pulmonary autograft has been shown to grow after implantation, reoperation on the left ventricular outflow tract is likely to be avoided.
Institutional address: Division of Cardiothoracic Surgery University of California San Francisco USA.