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

Yoon, Dong Woog; Yang, Ji-Hyuk; Jun, Tae-Gook; Park, Pyo Won

doi:10.5090/kjtcs.2017.50.4.235

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…One is for the surgical repair of the aortic valve ( 7 - 10 ). The second is for repair of trunco-conal congenital heart defects associated with anomalous origin of the coronary arteries, or requiring reimplantation of the coronary arteries such as an arterial switch, aortic translocation, or Ross procedure ( 11 - 13 ).…”

Section: Introductionmentioning

confidence: 99%

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries

Koerner,

Cunningham,

Marshall

et al. 2023

Transl Pediatr

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Background Asymmetry of the aortic valve leaflets has been known since Leonardo Da Vinci, but the relationship between size and shape and origin of the coronary arteries has never been examined. Our aim was to evaluate this anatomy in a population of pediatric patients using a cross-sectional study design. Methods Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: (I) bicuspid aortic valve; (II) aortic valve stenosis; (III) hypoplasia of aortic valve annulus, or aortic root; (IV) truncal valve; (V) coronary artery atresia; (VI) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view in the isovolumic phase of systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac computed tomography (CT) scan and magnetic resonance imaging (MRI), and operative notes were reviewed to identify origin of coronary arteries. Results Two hundred sixty-one pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6±4.3 years, weight 12.87±17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P<0.001), while the right and left had equal areas, but different shape, with the left leaflet longer (P<0.001) and narrower (P=0.005) than the right. With the major source of blood flow from the right coronary sinus, the non-coronary leaflet was still the longest. However, there was no statically significant difference between the size and shape previously observed between the right and left leaflets. Conclusions Our study showed asymmetry of size and shape among aortic valve leaflets, and a relationship with coronary artery origin. The complex aortic root anatomy must be approximated to optimize function of any surgical repair. These findings also may prove useful in the pre-operative definition of coronary artery anatomy and in the recognition of coronary artery anomalies.

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Section: Introductionmentioning

confidence: 99%

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries

Koerner,

Cunningham,

Marshall

et al. 2023

Transl Pediatr

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Contemporary Surgical Approaches in Pediatric Aortic Valve Surgery: A Retrospective Comparison of Three Techniques

Komarov,

Shumakov,

Chernov

et al. 2024

Journal of Cardiac Surgery

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Background: Congenital aortic valve (AV) disease is viewed in 2% of the population and in 20 out of 1000 neonates are presented with bicuspid configuration. Treatment of the congenital AV diseases requires multiple interventions. The ultimate goal is to provide adequate close to physiological left ventricle outflow and minimization of regurgitation. The optimal operative management of AV disease in children and young adults remains controversial. AV neocuspidization with glutaraldehyde‐treated autologous pericardium may be a satisfactory alternative in pediatric cardiac surgery.Objectives: The data of the AVNeo procedure results enable a comparative analysis of various AV reconstructive approaches in the pediatric cohort. In this article, we present the comparative study of various techniques in pediatric AV surgery, including the immediate and midterm outcomes of AVNeo, commissurotomy with aortic leaflet augmentation using pericardial patch (“free style” technique), and Ross procedure.Study Design: We conducted a retrospective analysis of the early and midterm results of surgical AV disease treatment of 44 children in 5 cardiac surgery centers from 2014 to 2022. The patients were divided into 3 groups: group I: glutaraldehyde‐treated autologous pericardium AVNeo (n = 12), group II: “free style” technique (n = 10), and group III: Ross procedure (n = 22). We described the immediate and midterm outcomes. The study design was approved by the ethics committees of the participating centers.Results: A total of 44 children after surgical treatment of the AV disease in 5 cardiac surgery centers were included in the study and were grouped as group I: AVNeo (n = 12), group II: “free style” technique (n = 10), and group III: Ross procedure (n = 22). The median follow‐up period was 57 ± 23.8 months. In‐hospital mortality was 4.5% (n = 2). In the midterm follow‐up, the peak pressure gradient was 18.45 ± 4.63 mmHg for group I and 8.9 ± 1.6 mmHg for group III (p = 0.00001), respectively. The cumulative freedom from reoperations was 100%, 30%, and 95.2% for 40 months of follow‐up and 100%, 30%, and 83.4% for 70 months of follow‐up in I, II, and III groups, respectively. No cases of midterm mortality were detected in all groups.Conclusion: The AV neocuspidization with glutaraldehyde‐treated autologous pericardium has an enormous advantage in pediatric AV surgery, significantly surpassing the freedom from resurgery of repair procedures and having comparable results with the Ross procedure in the midterm follow‐up.

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Aortic Valve Leaflets Are Asymmetric and Correlated With the Origin of Coronary Arteries

Koerner

Cunningham

Marshall

et al. 2023

Preprint

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Background. Aortic valve leaflets asymmetry has been known since Leonardo Da Vinci, but our aim was to evaluate their relationship between size and shape, not defined in children, which we hypothesized correlated with coronary arteries origin. Methods. Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: a) bicuspid aortic valve, b) aortic valve stenosis, c) hypoplasia of aortic valve annulus, or aortic root; d) truncal valve, e) coronary artery atresia, f) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view at the period of isovolumetric contraction in systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac CT scan and MRI, and operative notes were reviewed to identify origin of coronary arteries. Findings. 261 pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6 ± 4.3 years, weight 12.87 ± 17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P < 0.001), while the right and left had equal areas, but different shape, with the left leaflet longer (P < 0.001) and narrower (P = 0.005) than the right. With the major source of blood flow from the right coronary sinus, the non-coronary leaflet was still the longest. However, there was no statically significant difference between the size and shape previously observed between the right and left leaflets. Conclusions. Our study showed asymmetry of size and shape among aortic valve leaflets, and a correlation with coronary artery origin. The complex aortic root anatomy must be approximated to optimize function of any surgical repair. These findings also may prove useful in the pre-operative definition of coronary artery anatomy and in the recognition of coronary artery anomalies.

show abstract

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

Cited by 3 publications

References 19 publications

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries

Contemporary Surgical Approaches in Pediatric Aortic Valve Surgery: A Retrospective Comparison of Three Techniques

Aortic Valve Leaflets Are Asymmetric and Correlated With the Origin of Coronary Arteries

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