20 years experience with the Ross operation in middle-aged patients: the autologous principle is still alive

Costa, Francisco Diniz Affonso da; Colatusso, Daniele Fornazari; Filho, Eduardo Mendel Balbi; Marchetti, Rafael; Ferreira, Andreia Dumsch de Aragon; Costa, Marise Brenner Affonso da; Roderjan, João Gabriel; Colatusso, Claudinei

doi:10.1093/icvts/ivw365

Cited by 10 publications

(11 citation statements)

References 26 publications

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“…15,19,20 Our experience with decellularized allografts for RVOT reconstruction during the Ross operation in young adults has shown lower late peak gradients and the absence of calcification when compared with the conventional cryopreserved counterpart. 21,22 Similar results have been previously reported not only for the Ross operation but also for patients with congenital heart disease. 20,23,24 .However, these series include mostly older children and young adults.…”

Section: Discussionsupporting

confidence: 84%

“…This has already been demonstrated in our experience with decellularized allografts in young adults submitted to the Ross operation and now confirmed in the much more critical subgroup of children below 12 years of age. 21,22 Not less important, is the fact that decellularized allografts proved very resistant to infections, with no documented or suspected case of bacterial endocarditis in our series.…”

Section: Discussionmentioning

confidence: 69%

See 1 more Smart Citation

Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children

Costa

Etnel

Torres

et al. 2017

World J Pediatr Congenit Heart Surg

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 69%

Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children

Costa

Etnel

Torres

et al. 2017

World J Pediatr Congenit Heart Surg

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“…These series reinforce previously published results showing low hospital mortality and excellent long-term survival with the Ross operation ( 17 , 19, 20 ). One of its advantages is the diminished risk of thromboembolism and no need for anticoagulation which impacts positively on quality of life ( 21 , 22 ).…”

Section: Surgical Optionssupporting

confidence: 91%

Surgery for Young Adults With Aortic Valve Disease not Amenable to Repair

et al. 2018

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Aortic valve replacement is the gold standard for the management of patients with severe aortic stenosis or mixed pathology that is not amenable to repair according to currently available guidelines. Such a simplified approach may be suitable for many patients, but it is far from ideal for young adults considering emerging evidence demonstrating that conventional valve replacement in this cohort of patients is associated with inferior long-term survival when compared to the general population. Moreover; the utilisation of mechanical and bioprosthetic valves can significantly impact on quality and is linked to increased rates of morbidities. Other available options such as stentless valve, homografts, valve reconstruction and Ross operation can be an appealing alternative to conventional valve replacement. Young patients should be fully informed about all the options available - shared decision making is now part of modern informed consent. This can be achieved when referring physicians have a better understanding of the short and long term outcomes associated with every intervention, in terms of survival and quality of life. This review presents up to date evidence for available surgical options for young adults with aortic stenosis and mixed disease not amenable to repair.

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“…These numbers vary considerably depending on patient diagnosis, age and procedure. For example, patients who underwent the Ross procedure had 92% freedom from reintervention after 16 years (Da Costa et al 2017), while a young patient group (\ 1 year) with more complex diagnoses showed 38% freedom from reintervention after 10 years (Vitanova et al 2014). When collecting and preparing a homograft, several aspects have to be considered.…”

Section: Introductionmentioning

confidence: 99%

Impact of valve fenestrations and structural changes in homografts on the long-term outcome in the recipient

2021

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Homografts have long been used for right ventricular outflow tract (RVOT) reconstruction. Tissue banks struggle to meet the clinical demand of tissue, with insufficient donor availability and strict recommendations on tissue quality with high proportions of discards. This study analyzes the long-term outcome of patients receiving a homograft with small fenestrations of the cusps or other structural changes, to evaluate if minor impairment of the homograft affects the durability. Homograft characteristics and patient outcome were described. Follow-up was maximum 24 years. Structural changes of the homografts were analyzed in relation to patient outcome, using univariable and multivariable Cox proportional hazard regression. Between 1995 and 2018, 468 patients received 535 homografts in the RVOT in Lund. Median recipient age was 13 years. There were 137 (26.9%) reinterventions. Freedom from reintervention was 75.8% (95% CI 71.3–79.7%) at 10 years and 57.4% (95% CI 50.0–64.0%) at 20 years. Small fenestrations of the cusps, fibrosis of the cusps and minor atheromatosis of the vessel did not show any statistically significant impact on long-term outcome, hazard ratio = 0.46 (95% CI 0.11–1.87, p = 0.276) and hazard ratio = 0.80 (95% CI 0.25–2.56, p = 0.704). Minor structural changes of the homografts seem to be acceptable without affecting the long-term durability.

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20 years experience with the Ross operation in middle-aged patients: the autologous principle is still alive

Cited by 10 publications

References 26 publications

Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children

Decellularized Allografts for Right Ventricular Outflow Tract Reconstruction in Children

Surgery for Young Adults With Aortic Valve Disease not Amenable to Repair

Impact of valve fenestrations and structural changes in homografts on the long-term outcome in the recipient

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