Two decades’ experience with aortic valve replacement with pulmonary autograft

Matsuki, Osamu; Okita, Yutaka; Almeida, Roberto Simões de; McGoldrick, John; Hooper, Timothy L.; Robles, Alfonso; Ross, Donald N.

doi:10.1016/s0022-5223(19)35740-x

Cited by 135 publications

(32 citation statements)

References 18 publications

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“…The incidence of complete heart block after the Ross procedure varies from 0% to 6%. 11,[22][23][24] In the present series, permanent, complete heart block did not occur, despite the fact that 19 of 25 patients (76%) within the complex group had an annulusenlarging procedure. Although there was transient heart block in 4 patients within this cohort, all were discharged in normal sinus rhythm.…”

Section: Discussioncontrasting

confidence: 48%

“…Elkins et al 2 reported 1 early death secondary to a fatal arrhythmia. Similarly, in a 20-year follow-up of a pulmonary autograft cohort by Matsuki and colleagues, 23 there was 1 early and 1 late death attributed to arrhythmia. The higher incidence of identified perioperative ventricular tachycardia in this study may result from our methodology, incorporating 24-hour full-disclosure telemetry, but is also more likely to be attributable to the complexity of this cohort of patients.…”

Section: Discussionmentioning

confidence: 82%

“…All 3 patients who required reoperation had complex left heart disease. Reoperation for mediastinal bleeding was required in 8.5% of a cohort with complex left heart obstruction followed up by Reddy et al, 13 in 4.0% of a cohort followed up by Elkins et al, 10 and in 1.2% of patients in a group followed up by Matsuki et al 23 Both Starnes et al 15 and Reddy et al 13 have reported results for the Ross procedure in patients with complex left heart disease with durations of mechanical ventilation and hospital length of stay similar to those of the present series. For the complex group within our cohort, the median duration of mechanical ventilation was 17 hours, median length of stay in the intensive care unit was 3 days, and median total hospital length of stay was 6 days.…”

Section: Discussionmentioning

confidence: 96%

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Early Results of the Ross Procedure in Simple and Complex Left Heart Disease

Marino

Wernovsky²,

Rychik³

et al. 1999

Circulation

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Background-The Ross procedure has been used increasingly to treat aortic valve disease in children and young adults. Benefits include the lack of anticoagulation after surgery and the potential growth and durability of the autograft. The purpose of this study was to review our institutional experience with the Ross procedure and to compare early outcome in simple aortic valve disease and complex left heart disease. Methods and Results-Between January 1995 and October 1998, 66 patients (median age, 10.8 years; range, 6 days to 34.8 years) underwent the Ross procedure. The primary indication for surgery was isolated valvular disease in 41 patients: aortic stenosis (AS; nϭ3), aortic insufficiency (AI; nϭ11), and AS/AI (nϭ27). The remaining 25 patients had multiple levels of left ventricular outflow tract obstruction, 12 of whom had at least moderate AI. Additional left heart disease in the complex group included subaortic stenosis (nϭ20), arch obstruction (nϭ7), mitral valve disease (nϭ5), apical aortic conduit stenosis or insufficiency (nϭ3), and supravalvar AS (nϭ2). There were 123 prior interventions performed in 51 patients, including aortic valvotomy/valvuloplasty (nϭ56), coarctation repair (nϭ21), subaortic stenosis resection/Konno procedure (nϭ10), ventricular septal defect closure (nϭ8), apical aortic conduit placement (nϭ3), aortic valve replacement (nϭ3), and other (nϭ22). An isolated Ross procedure was performed in 41 patients, 10 of whom required concurrent aortic annulus enlargement procedure to accommodate the larger pulmonary autograft. In the remaining 25 patients, 49 concurrent procedures were performed, including the Konno procedure (nϭ17), aortic annulus enlargement (nϭ2), subaortic membrane resection (nϭ9), arch augmentation (nϭ5), mitral valvuloplasty (nϭ5), ventricular septal defect closure (nϭ4), apicoaortic conduit division (nϭ3), and other (nϭ4). One patient (1.5%) died 3 days after a Ross-Konno procedure, which included arch reconstruction, from presumed arrhythmia. There were no other early deaths. One patient required ECMO (extracorporeal membrane oxygenation) for 3 days after a ventricular tachycardia (VT)-related cardiac arrest. Transient complete heart block was seen in 4 patients; the duration was Ͻ5 days. No patient had left ventricular outflow tract obstruction on discharge echocardiography. Neo-AI was graded as none (nϭ5), trivial-mild (nϭ57), or moderate (nϭ3). All 3 patients with moderate neo-AI at discharge had abnormal pulmonary valves before surgery. Perioperative VT was noted in 18 patients (27.2%), 2 of whom were discharged on antiarrhythmic medication. Conclusions-The Ross procedure can be performed in isolation or in combination with other complex procedures with low mortality (1.5%) and acceptable short-term results, even in patients with complex left heart disease and multiple prior interventions. Postoperative VT is common. Anatomic abnormalities of the pulmonary valve preclude its use as an autograft. (Circulation. 1999;100[suppl II]:II-162-II-166.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 96%

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Early Results of the Ross Procedure in Simple and Complex Left Heart Disease

Marino

Wernovsky²,

Rychik³

et al. 1999

Circulation

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“…Relief of complex left ventricular outflow tract obstruction can also be efficiently accomplished with pulmonary autografts. [3][4][5] The septal opening, made through the intercoronary commissure, is in a different location compared with the Konno operation. The intercoronary commissure landmark is out of reach of the atrioventricular conducting tissue.…”

Section: Discussionmentioning

confidence: 99%

A new aortoventriculoplasty for prosthetic aortic valve replacement

Hvass

Baron

Elsebaey

2003

The Journal of Thoracic and Cardiovascular Surgery

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“…The transplanted liver showed normal laboratory parameters.On 24 November 1991 cardiac surgery was performed with a cryopreserved aortic homograft. This was implanted according to the technique described by Ross and colleagues [7]. The postoperative course was uneventful and immunosuppression was continued.…”

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confidence: 99%

Homograft replacement of the aortic valve after liver transplantation

et al. 1993

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Sir: Endocarditis can be a severe long-term complication that is associated with a high mortality rate in transplanted patients. Valve replacement can be performed either with a bioprosthetic valve (as is done in our department when a patient is over 70 years of age) or with a mechanical replacement device (when the patient is less than 70 years of age) or a homograft (in patients younger than 70) in aortic position. Homografts have several advantages over other devices, namely: (1) there is no need for anticoagulation;(2) there is no noise, which patients often find annoying;(3) there is longer durability; and (4) there is a lower incidence of endocarditis [3,8] with, consequently, a lower incidence of reoperation.We report on a 62-year-old man who underwent a liver transplantation in April 1990 because of hepatocellulary carcinoma. He had been maintained on a triple immunosuppressive therapy. The patient was in good health and had no complications after the operation. In September 1990, however, the patient experienced an onset of fatigue, chest pain, lower leg edemas, and increasing dyspnea. In October 1991 he was admitted to a hospital with congestive heart failure and bilateral pleural effusions. Conservative treatment did not result in any significant improvement, and so there was further evaluation. Cardiac catheterization was performed; this revealed combined aortic valve incompetence grade 111 and stenosis grade 1-11, mitral valve incompetence grade I1 with no coronary stenoses. The transplanted liver showed normal laboratory parameters.On 24 November 1991 cardiac surgery was performed with a cryopreserved aortic homograft. This was implanted according to the technique described by Ross and colleagues [7]. The postoperative course was uneventful and immunosuppression was continued. Postoperative echocardiography showed regular homograft valve function. Postoperative serial liver function tests were also performed. Except for once, on the 2nd day, the direct bilirubin in serum increased up to 1.56 mg/dl; all liver tests showed normal parameters.Nine months have elapsed since the aortic valve replacement. We had two follow-up check-ups, at 3 and 6 months post-transplantation. Both times echocardiography (valve incompetence grade I), red and white blood count, and X-rays of the chest showed no pathologic findings. The patient is clinically in class I, according to the New York Heart Association. Since the valve replacement there have not been any episodes of endocarditis and no further invasive procedures. The post-transplant follow-up is generally not done in our hospital, so we contacted the clinic in which this is performed. The patient had his last follow-up examination in July 1992. All posttransplant liver parameters were within the normal ranges.Heart valve operations have been performed after cadaver renal transplantation in many cases [5, 91. To our knowledge, there has been no homograft transplantation in liver-transplanted patients. In a review of the literature we could not find an exact percent...

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Two decades’ experience with aortic valve replacement with pulmonary autograft

Cited by 135 publications

References 18 publications

Early Results of the Ross Procedure in Simple and Complex Left Heart Disease

Early Results of the Ross Procedure in Simple and Complex Left Heart Disease

A new aortoventriculoplasty for prosthetic aortic valve replacement

Homograft replacement of the aortic valve after liver transplantation

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