Hemodynamic performance during maximum exercise in adult patients with the Ross operation and comparison with normal controls and patients with aortic bioprostheses

Pîbarot, Philippe; Dumesnil, Jean G.; Briand, Martin; Laforest, Isabelle; Cartier, P

doi:10.1016/s0002-9149(00)01134-6

Cited by 51 publications

(21 citation statements)

References 22 publications

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“…Our study adds to prior reports by comparing exercise performance before and after the procedure, and in assessing metabolic parameters and cardiac output with exercise in children. [15][16][17][18][19][20][21][22][23][24] The results of our study confirm in children similar findings previously seen in the adult population. In the only other report measuring aerobic capacity following the Ross operation, Pibarot et al measured maximal oxygen consumption and anaerobic threshold using a similar ramp cycle protocol.…”

Section: Discussionsupporting

confidence: 88%

Exercise performance in children and adolescents after the Ross procedure

et al. 2006

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Section: Discussionsupporting

confidence: 88%

Exercise performance in children and adolescents after the Ross procedure

et al. 2006

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“…Obviously it is difficult to draw firm conclusion given the small number of patients studied: 52 between both series. Nevertheless, the data agree with previous work in adult Ross patients that indicated better functional outcomes for this surgery compared with prothetic valves or aortic homograft [3,12,16,23]. Ross surgery appears to be a good choice for athletic patients who are interested in maximizing their postoperative exercise capacity (with the additional benefit of avoiding anticoagulation).…”

Section: Discussionsupporting

confidence: 87%

“…An early study used dobutamine stress test in patients with aortic autograft with encouraging results [3]. Two other groups performed exercise stress echocardiography in adult cohorts after Ross surgery and compared them with normal controls and patients with aortic homograft [12,16,23]. Both groups found a better result after Ross surgery both at rest and after stress echocardiography compared with aortic homograft.…”

Section: Introductionmentioning

confidence: 99%

Exercise Stress Echocardiography After Childhood Ross Surgery: Functional Outcome in 26 Patients From a Single Institution

et al. 2012

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Adult studies suggest a better functional outcome after aortic valve replacement with a pulmonary autograft compared with mechanical or homograft valves. Little is known about functional results after Ross surgery in growing children. This study reports formal exercise stress echocardiographic data from 26 pediatric Ross patients. A retrospective cohort study analyzed stress echocardiographic data of patients who underwent Ross surgery as a child (<17 years old). All patients were operated by a single surgeon and underwent a Bruce protocol stress echocardiogram on the treadmill. Twenty-six patients (4 girls) were 9.3 ± 5.0 years at surgery and 14.9 ± 3.5 years (range 6.6-19.7 years) at follow-up. Mean follow-up was 5.4 ± 3.7 years (median 4.2). All were asymptomatic. The exercise time was normal in 87% of cases at 12.8 ± 2.5 min. On stress echocardiography, the mean right-ventricular outflow tract (RVOT) gradient increased from 38 ± 22 mmHg at rest to 82 ± 33 mmHg after exercise, but this did not correlate with exercise times. Stress echocardiography is useful in evaluating patients after childhood Ross surgery for aortic valve disease. In this pediatric cohort, most patients achieved normal exercise capacity. The presence of mild or moderate RVOT obstruction had no significant impact on exercise capacity.

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“…Takovýchto nízkých fyziologických gradientů nedosahuje žádná jiná chlopenní náhrada. Dokonce ani při zátěži nedochází k nárůstu transvalvulárního gradientu [30]. Rovněž při studiu charakteru průtoku přes aortální kořen pomocí čtyřrozměrné magnetické rezonance (MR) byl pouze u Rossovy operace prokázán charakter průtoku téměř shodný s průtokem normálním aortálním kořenem [31].…”

Section: Hemodynamikaunclassified

Current status of the Ross procedure in aortic valve surgery

et al. 2017

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Rossova operace je unikátním chirurgickým konceptem, který řeší nereparabilní postižení aortální chlopně její náhradou vlastní chlopní plicnice. Výtokový trakt pravé komory je po vytnutí plicnice rekonstruován transplantací pulmonálního alograftu. Plicnicová chlopeň v aortální pozici (pulmonální autograft) vysoce předčí jiné náhražky svými hemodynamickými vlastnostmi, viabilitou se schopností růstu (u dětských pacientů) a nízkým rizikem tromboembolismu a infekční endokarditidy. Přes nesporné výhody pulmonálního autograftu vzbuzuje Rossova operace kontroverze a chirurgický respekt, protože jde o technicky náročný výkon, který navíc představuje pro další chlopeň riziko komplikací a předpokládané reoperace. Renesance zájmu o Rossovu operaci je způsobena zejména poznáním kritických kroků, standardizací operace i znalostí dlouhodobých výsledků. Ve velkých sestavách nemocných byly prokázány významné výhody pro nemocné v podobě vynikajícího přežívání, nízké četnosti komplikací a vysoké kvality života. Pokud je Rossova operace prováděna ve specializovaných centrech s důrazem na technické detaily zajišťující dlouhodobou stabilitu autograftu i alograftu, je atraktivní alternativou zejména pro mladé nemocné s postižením aortální chlopně.

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Hemodynamic performance during maximum exercise in adult patients with the Ross operation and comparison with normal controls and patients with aortic bioprostheses

Cited by 51 publications

References 22 publications

Exercise performance in children and adolescents after the Ross procedure

Exercise performance in children and adolescents after the Ross procedure

Exercise Stress Echocardiography After Childhood Ross Surgery: Functional Outcome in 26 Patients From a Single Institution

Current status of the Ross procedure in aortic valve surgery

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