Dissection in a pulmonary autograft

The Ross–Yacoub procedure for aneurysmal autograft roots: A strategy to preserve autologous pulmonary valves

“…5,23,24 Comparison with prior studies is hampered by the paucity of series comparing the 3 operative techniques. 3,7,16,23 Nonetheless, the observation that both the prevalence of root dilatation and freedom from root dilatation in Ross series exclusively using the root technique are strikingly similar to the results herein corroborates the effect of the operative technique. 1,3,4,[20][21][22][23][24] On the contrary, the previously reported protective effect conferred by pericardial buttressing of proximal and distal autograft anastomoses 5 did not emerge at extended follow-up.…”

“…The SAS software (release 9.1; SAS Institute, Inc, Cary, NC) was used for statistical analysis. A comprehensive review of all reported cases of autograft root remodeling with valve preservation and of root replacement 4,[8][9][10][11][12][15][16][17][18][19][20][21][22][23] was also undertaken.…”

“…Conservative management of autograft root pathology, until recently conceivable, 5 appears narrow sighted in light of available evidence on the progression of valve regurgitation and, most importantly, on abrupt complications, such as dissection, which is reported in 5% of aneurysmal autografts (Table 4). [8][9][10][11][12][13][15][16][17][18][19]22,23 Based on these considerations, we prospectively applied surgical indications, adopting the criterion proposed by Svensson and colleagues 14 for native root pathology in patients with Marfan syndrome and a bicuspid aortic valve. The choice was based on 2 considerations.…”

“…Second, histologic changes in aneurysmal autografts are similar to those seen in bicuspid aortic walls, as observed herein and by others. Analysis of worldwide clinical experience shows that of 103 reoperative procedures on the autograft root reported during the last 12 years, 4,[8][9][10][11][12][15][16][17][18][19][20][21][22][23] 28 (26%) resulted in preservation of the autologous pulmonary valve (Table 4). Reports of valve-sparing operations were mostly anecdotal, except for this study and 3 other series comprising 2 to 8 patients, 11,20,23 with clinical and echocardiographic follow-up exceeding 1 year in only this study and 2 other reports (overall average, 1.8 AE 1.3 years; median, 0.5 years; range, 0.3-4.6 years).…”

Should we still do the Ross operation in adults?

“…Dissection occurring in dilated pulmonary autografts has been reported in at least four instances [2,[23][24][25]. This is of great concern as the number of patients who develop dilatation of the autograft continues to increase over time.…”