European multicenter experience with valve-sparing reoperations after the Ross procedure

Mookhoek, Aart; Kerchove, Laurent de; Khoury, Gébrine El; Weimar, Timo; Luciani, Giovanni Battista; Mazzucco, Alessandro; Bogers, Ad J.J.C.; Aicher, Diana; Schäfers, Hans Joachim; Charitos, Efstratios I.; Stierle, Ulrich; Takkenberg, Johanna J.M.

doi:10.1016/j.jtcvs.2015.08.043

Cited by 44 publications

(41 citation statements)

References 12 publications

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“…1) In the largest series to date, approximately 20% of patients required concomitant surgery to correct RVOT stenosis. 2) Here, we demonstrate that all valves can be surgically repaired or replaced safely during autograft Valve-Sparing Root Replacement Post-Ross VSRR. As more patients are considered for VSRR, coexistent mitral, tricuspid, and pulmonic valve dysfunction should not preclude salvage of the autograft valve, nor should autograft leaflet prolapse.…”

Section: Discussionmentioning

confidence: 66%

“…The variant of the VSRR likely impacts durability. 2) We favor the reimplantation technique in all scenarios, regardless of complexity. 5) We have also had early success with direct autograft leaflet repair to enhance repairability.…”

Section: Discussionmentioning

confidence: 99%

“…However, growing experience with VSRR has translated to some choosing to salvage the autograft valve. 1,2) Reports of autograft VSRR demonstrate low operative mortality, often with rates lower than that of the index Ross procedure. 2) Furthermore, retaining the autograft valve reduces risk of thromboembolism, hemorrhage, and infection.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Autograft Valve-Sparing Root Replacement for Late Ross Failure during Quadruple-Valve Surgery

Goldstone

Jensen

Bilbao

et al. 2017

ATCS

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Autograft Valve-Sparing Root Replacement for Late Ross Failure during Quadruple-Valve Surgery

Goldstone

Jensen

Bilbao

et al. 2017

ATCS

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“…The estimated rate of freedom from adverse outcomes of the pulmonary autograft in our study was 88% and 70% at 5 and 10 years, respectively. Regarding the reoperation method for the pulmonary autograft, previous reports have suggested a valve-sparing operation [ 17 ] under the belief that dilatation of the neo-aortic root was the main cause of aortic insufficiency. However, David et al [ 16 ] found abnormal cusps at reoperation that precluded aortic valve sparing in most patients.…”

Section: Discussionmentioning

confidence: 99%

The Ross Procedure in Pediatric Patients: A 20-Year Experience of Ross Procedure in a Single Institution

Yoon

Yang

Jun

et al. 2017

Korean J Thorac Cardiovasc Surg

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BackgroundThe Ross/Ross-Konno procedure is considered a good option for irreparable aortic valve disease in pediatric patients because of its hemodynamic performance and potential for growth of the pulmonary autograft. This study is a review of the long-term results of our 20-year experience with the Ross and Ross-Konno operations in a single institution.MethodsBetween June 1995 and January 2016, 16 consecutive patients (mean age, 6.0±5.9 years; range, 16 days to 17.4 years) underwent either a Ross operation (n=9) or a Ross-Konno operation (n=7). The study included 12 males and 4 females, with a median follow-up period of 47 months (range, 6 to 256 months).ResultsThere were no cases of in-hospital or late mortality. Six reoperations were performed in 5 patients. Four patients underwent right ventricular-pulmonary artery (RV-PA) conduit replacement. Two patients underwent concomitant replacement of the pulmonary autograft and RV-PA conduit 10 years and 8 years after the Ross operation, respectively. The rate of freedom from adverse outcomes of the pulmonary autograft was 88% and 70% at 5 and 10 years, respectively. The rate of freedom from valve-related reoperations was 79% and 63% at 5 and 10 years, respectively.ConclusionPulmonary autografts demonstrated good durability with low mortality. The Ross/Ross-Konno procedure is a good option that can be performed safely in pediatric patients with aortic valve disease, even in a small-volume center.

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“…Reintervention remains the main concern as there is a perception that the rates are high and this may be associated with increased morbidity and mortality ( 14 , 15 ). Reports on outcomes of reintervention after Ross however persistently demonstrated that it can be performed safely and that the autograft itself can sometimes be salvaged by repair or even valve-sparing reimplantation ( 31 – 33 ).…”

Section: Surgical Optionsmentioning

confidence: 99%

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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European multicenter experience with valve-sparing reoperations after the Ross procedure

Cited by 44 publications

References 12 publications

Autograft Valve-Sparing Root Replacement for Late Ross Failure during Quadruple-Valve Surgery

Autograft Valve-Sparing Root Replacement for Late Ross Failure during Quadruple-Valve Surgery

The Ross Procedure in Pediatric Patients: A 20-Year Experience of Ross Procedure in a Single Institution

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

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