Early and mid-term results of autograft rescue by Ross reversal: A one-valve disease need not become a two-valve disease
| Autor: | David Majdalany, Penny L. Houghtaling, Aaron N. Dunn, Eugene H. Blackstone, Gösta B. Pettersson, Robert D. Stewart, Hani K. Najm, Lars G. Svensson, Syed T. Hussain |
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| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male Reoperation medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Mid term results Patient characteristics 030204 cardiovascular system & hematology Prosthesis Design 03 medical and health sciences Young Adult 0302 clinical medicine Aortic valve replacement Risk Factors medicine Humans Autografts Aged Bioprosthesis Heart Valve Prosthesis Implantation Pulmonary Valve business.industry Medical record Ross procedure Operative mortality Hemodynamics Recovery of Function Middle Aged medicine.disease Surgery Prosthesis Failure Pulmonary valve function Treatment Outcome 030228 respiratory system Anesthesia Aortic Valve Heart Valve Prosthesis Replantation Female Cardiology and Cardiovascular Medicine business Valve disease |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 155(2) |
| ISSN: | 1097-685X |
| Popis: | Objectives Risk of reoperation and loss of a second native valve are major drawbacks of the Ross operation. Rather than discarding the failed autograft, it can be placed back into the native pulmonary position by "Ross reversal." We review our early and mid-term results with this operation. Methods From 2006 to 2017, 39 patients underwent reoperation for autograft dysfunction. The autograft was successfully rescued in 35 patients: by Ross reversal in 30, David procedure in 4, and autograft repair in 1. Medical records were reviewed for patient characteristics (mean age was 46 ± 13 years, range 18-67 years, and 23 were male), previous operations, indications for reoperation, hospital outcomes, and echocardiographic findings for the 30 patients undergoing successful Ross reversal. Follow-up was 4.1 ± 3.5 years (range 7 months-11 years). Results Median interval between the original Ross procedure and Ross reversal was 12 years (range 5-19 years). Eight patients also had absolute indications for replacement of the pulmonary allograft. There was no operative mortality. One patient required reoperation for bleeding. Another had an abdominal aorta injury from use of an endoballoon clamp. There was no other major postoperative morbidity, and median postoperative hospital stay was 7.2 days (range 4-41 days). No patient required reoperation during follow-up. Twenty-four patients had acceptable pulmonary valve function, and 6 had clinically well-tolerated moderate or severe pulmonary regurgitation. Conclusions Ross reversal can be performed with low morbidity and acceptable pulmonary valve function, reducing patient risk of losing 2 native valves when the autograft fails in the aortic position. |
| Databáze: | OpenAIRE |
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