Morbidity Following the Ross Operation

Abstract

Aortic valve replacement (AVR) with a pulmonary valve autograft (PVA) was first reported by Donald N. Ross in 1967. The expectation of this procedure was to avoid degenerative changes seen in other biological tissue valves such as calcification, attenuation, and rupture of the leaflets. Recent reports by the original investigator's group have confirmed the lack of degenerative changes in PVA. To corroborate their conclusions, the fate of 12 patients undergoing AVR with PVA by Dr. Gonzalez‐Lavin has been ascertained. From March 1969 to June 1971,12 patients underwent AVR with PVA. The right ventricular outflow tract (RVOT) was reconstructed with an aortic homograft valved conduit. The mean age was 42.7 years (range 21 to 52 years). The mean follow‐up for 11 hospital survivors is 12.4 years. Three PVAs have been replaced; one following infective endocarditis at 13 years, and two at 15 and 73 months due to technical malalignment. There was no evidence of PVA degeneration during histologic examination of these explanted PVA. Six patients are alive and retain the original PVA at 12 years (55%). This analysis corroborates the conclusions of Dr. Ross and strongly suggests an immunological mechanism in the process of calcification of other biological tissue valves. The Ross operation is believed to be the preferred method of AVR in young patients.

Inflammatory Reactions Following Homograft Insertion in Children with Congenital Heart Disease

“…Insertion of a valved homograft in congenital heart surgery was first performed in 1967 by Donald Ross (7,9,10). Since then the number of congenital heart defects for which such operations are performed has increased, and recently the indications have expanded to include younger children and even neonates (6,7,(11)(12)(13).…”

A comparison of macroscopic lipid content within porcine pulmonary and aortic valves: Implications for bioprosthetic valves

“…The long-term results with that procedure have been extremely good, and similar favorable results were recently reported by others. [16][17][18] In this pulmonaryto-aortic autograft, tissue degradation and calcification do not appear to be a problem. 18-2° Direct mechanical comparisons between porcine pulmonary valves and porcine aortic valves indicate that these valves have nearly identical mechanical properties.2~, 22 Although use of the porcine pulmonary valve as a replacement device has been suggested, its only described advantage has been its structural characteristics; the muscular shelf present in the porcine aortic valve right coronary cusp is not a feature of the pulmonary valve, and the latter therefore might have better hemodynamics.…”