Ross Operation in the Young: A Ten-Year Experience
| Autor: | Giovanni Battista Luciani, Alessandro Mazzucco, Francesco Santini, Gianluca Casali, Alessandro Favaro |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Thorax medicine.medical_specialty Time Factors Adolescent MECHANICAL PROSTHESES medicine.medical_treatment Aortic Valve Insufficiency CHILDREN Regurgitation (circulation) DISEASE ROOT Aortic valve replacement Bicuspid valve medicine Humans Cardiac Surgical Procedures POSITION Child PULMONARY AUTOGRAFT business.industry Ross procedure Mechanical Aortic Valve Aortic Valve Stenosis ADULTS Middle Aged medicine.disease congenital heart disease Surgery Stenosis surgical procedures operative medicine.anatomical_structure Pulmonary valve AORTIC-VALVE-REPLACEMENT REOPERATION POSITION congenital heart disease Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 80:2271-2277 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2005.03.018 |
| Popis: | Background The Ross operation is an alternative to mechanical aortic valve replacement in the young. However, early and late complications after operation have been reported. In order to assess the role of the Ross operation in children and young adults, a 10-year clinical experience was reviewed. Methods Ninety male and 22 female patients, aged 29 ± 10 years (range, 6–49) underwent cross-sectional clinic and echocardiographic examination. Indication for Ross operation was aortic regurgitation in 79 patients, stenosis in 11, and mixed lesion in 22; 82 (73%) had a bicuspid valve. Endpoints of the study were survival and freedom from autograft dilatation, from autograft and homograft dysfunction, and from reoperation. Results There was 1 (1%) hospital and 1 late (1%) death, during an average follow-up of 5.1 ± 1.9 years (range, 0.1–10.6). At 10 years, survival was 98 ± 2%. Late autograft dilatation was identified in 32 (29%) patients and regurgitation in 15 (14%), 7 of whom had autograft dilatation. Ten-year freedom from autograft dilatation was 43 ± 8% and from regurgitation was 75 ± 8%. Multivariate analysis showed younger age ( p = 0.05), preoperative aortic root dilatation ( p = 0.02), root replacement technique ( p = 0.03), and absence of pericardial strip buttressing ( p = 0.04) to be predictive of autograft dilatation. Eleven (10%) patients required reoperation on the autograft (8 prosthetic valve replacement, 3 autograft root repair). Ten-year freedom from reoperation was 72 ± 10% and from replacement of the autograft was 88 ± 5%. Pulmonary homograft obstruction was identified in 6 (5%) patients, requiring homograft replacement in 1. All but 2 (2%) patients were in New York Heart Association class I, with a return to regular school grade or active employment. Conclusions Late outcome for the Ross procedure is excellent in terms of survival and quality of life. Late root dilatation, autograft regurgitation, and homograft stenosis, however, show increasing prevalence with time. Technical modifications of the procedure, yearly aortic root imaging, and early reintervention on the dilated neoaortic root may further enhance the durability of the autologous pulmonary valve. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|