Outcome of 40 consecutive cases of modified Ross procedure using novel Dacron valved conduit

Abstract

Objective The Ross procedure is an established option for aortic valve disease in children. Due to limited availability of pulmonary homograft, we devised a novel technique for right ventricular outflow tract (RVOT) reconstruction by preparing indigenous Dacron valved conduit. Methods Forty consecutive cases of modified Ross procedure done at our center (2013-2018) were analyzed. Thirty-seven patients (95%) were followed up with median duration of 2.5 (0.08-5.5) years. Median age was 12 (5-39) years. Nineteen (47.5%) patients had rheumatic aortic valve disease, while 19 (47.5%) had congenital aortic valve disease. Aortic root replacement with pulmonary autograft was performed in all patients. Dacron conduit for RVOT reconstruction was used with on table sewn bileaflet valve using Dacron patch (n = 22), expanded polytetrafluoroethylene (ePTFE) membrane (n = 10), bioprosthetic valve (n = 4), and pericardium (n = 4). Additional surgical procedures included mitral valve repair (n = 10), septal myectomy (n = 2), ascending aorta replacement (n = 1), ruptured sinus of valsalva (RSOV) repair (n = 1), and ventricular septal defect (VSD) closure (n = 1). Results There was one in-hospital mortality while one late death occurred at 3.5 years postoperatively. The neo-aortic valve regurgitation on echocardiographic evaluation at last follow-up was trivial (n = 28), mild (n = 7), and moderate (n = 2). Mild RVOT obstruction was present in 8 patients while 18 patients had mild pulmonary regurgitation. No patient required reintervention during follow-up. Conclusion Our early results of modified Ross procedure are encouraging, however, long-term follow-up is required.

Survival and freedom from reoperation after the Ross procedure in a Russian adult population: A single-center experience

“…The modified variants of the Ross procedure were proposed as the options to prevent late autograft dilatation and dysfunction and hence to reduce the rates of reoperations. 4 , 15 , 16 , 17 For the first 5 years, we used the full-root replacement technique. Since February 2014, we have employed the modified techniques of the Ross procedure, involving Dacron graft or autologous aortic wall.…”

A decellularized porcine pulmonary valved conduit embedded with gelatin

“…The appealing advantages of gelatin, such as its cell‐adhesive structure, low cost, off‐the‐shelf availability, high biocompatibility, biodegradability and low immunogenicity, have made it a desirable candidate for the development of biomaterials for tissue engineering and drug delivery 33 . Gelatin‐impregnated polyester‐woven artificial blood vessels have been used as conduits to reduce postoperative bleeding in clinics 7 . In this experiment, the pores of the decellularized PVCs were filled with gelatin, which could reduce the permeability of the decellularized scaffold.…”

“…33 Gelatin-impregnated polyester-woven artificial blood vessels have been used as conduits to reduce postoperative bleeding in clinics. 7 In this experiment, the pores of the decellularized PVCs were filled with gelatin, which could reduce the permeability of the decellularized scaffold.…”

“…Congenital malformations of the right ventricular outflow tract are found in 15%-20% of all congenital heart defect operations worldwide. 1 Pulmonary valved conduits (PVCs), which include allogeneic valved conduits, 2 valved bovine jugular vein conduits, 3,4 and polytetrafluoroethylene valved conduits, [5][6][7] are frequently used to reconstruct the right ventricular outflow tract. Due to long-term complications such as rejection, stenosis, 8 endocarditis, 9 thromboembolic events, and degeneration 10 the incidence of reoperation is high, and these materials cannot grow to adapt to the biology of young recipients.…”