Autograft Regurgitation and Aortic Root Dimensions After the Ross Procedure

Abstract

on behalf of the German Ross RegistryBackground-Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation. Methods and Results-Between

Pulmonary autograft in aortic position: is everything known?

“…Observational study (9,(14)(15)(16)18) and more recent randomized study controlled (23)(24)(25) have updated the previous work by including higher-risk patients and reflecting changes in clinical and surgical practice. These studies included large numbers of patients with different aortic disease pathogenesis who were treated with reinforcement of pulmonary autograft (23)(24)(25)51).…”

“…These studies included large numbers of patients with different aortic disease pathogenesis who were treated with reinforcement of pulmonary autograft (23)(24)(25)51). In the series of Elkins at 16 years (30), survival was 82%±6%, and hospital mortality was 3.9%.…”

Surgical Treatment of Bicuspid Aortic Valve Disease

“…The Ross operation is an acceptable alternative to conventional aortic valve replacement and has been shown to provide excellent hemodynamic results. The advantages of this therapeutic option are the use of a viable autologous valve and a low incidence of infection and thrombogenicity, avoidance of anticoagulant therapy, as well as its potential to grow in children (Hanke et al, 2007;Brown et al, 2010;Sievers et al, 2010;Ryan et al, 2011). Nevertheless, there is growing concern about autograft failure and surgical revisions because of the frequently concomitant aortic root and tubular ascending aorta pathology observed in many patients with BAV , and the intrisic abnormalities in the wall of the pulmonary artery based on the common embryological origin of the aortic and pulmonary root, which may contribute to progressive neoaortic root dilatation and AR, or both, when the pulmonary root is placed in the systemic position Siu & Silversides, 2010;Hanke et al, 2010).…”

“…Nevertheless, there is growing concern about autograft failure and surgical revisions because of the frequently concomitant aortic root and tubular ascending aorta pathology observed in many patients with BAV , and the intrisic abnormalities in the wall of the pulmonary artery based on the common embryological origin of the aortic and pulmonary root, which may contribute to progressive neoaortic root dilatation and AR, or both, when the pulmonary root is placed in the systemic position Siu & Silversides, 2010;Hanke et al, 2010). Progressive dilatation of the pulmonary autograft with or without regurgitation of the autograft valve is a common indication of reoperation Luciani et al, 2003;Takkenberg et al, 2006;Hanke et al, 2007;Ozaslan et al, 2009;Aljassim et al, 2011). In addition, factors contributing to a limited acceptance are the complexity of the operation and a dearth of long-term clinical information on the durability of the autograft in the aortic position and the durability of the pulmonary conduit substitute .…”

“…In addition, factors contributing to a limited acceptance are the complexity of the operation and a dearth of long-term clinical information on the durability of the autograft in the aortic position and the durability of the pulmonary conduit substitute . This concern has led many to reconsider the indication for the Ross operation in the adult population for whom other surgical options are available (Hanke et al, 2007;David, 2009). There are even some do not advocate the use of the Ross operation in patients with BAV disease (Siu & Silversides, 2010).…”