Document Detail

Reoperations for aortic aneurysm after the Ross procedure.
MedLine Citation:
PMID:  16359057     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: Among late complications after the Ross operation, autograft dilatation is likely the most common. In order to define prevalence, consequences and management of autograft dilatation, a 10-year clinical experience was reviewed. METHODS: A total of 112 patients (mean age 29 +/- 10 years) underwent cross-sectional echocardiographic follow up. End-points of the study were freedom from autograft dilatation (diameter >4 cm, indexed as 0.21 cm/m2) and from reoperation for dilatation. Risk factors for autograft dilatation were also identified. RESULTS: There were 110 late survivors; average follow up was 5.1 +/- 1.9 years (range: 0.3 to 10.6 years). At 10 years, autograft dilatation was identified in 32 patients (29%), compatible with aortic aneurysm (>5.0 cm) in seven patients (6%). Seven of 32 patients (22%) presented moderate or greater autograft insufficiency. Ten-year freedom from dilatation was 43 +/- 8%, and from regurgitation was 75 +/- 8%. At multivariate analysis, preoperative aneurysm (p = 0.02), root replacement technique (p = 0.03) and absence of root buttressing (p = 0.04) were predictive of dilatation. Reoperation for autograft aneurysm was performed in five patients at a mean of 7.3 +/- 0.8 years after the Ross procedure, while two patients await reintervention. Two patients had root replacement and three remodeling with valve preservation (two root replacements, one sinotubular junction replacement): all survived reoperation. Ten-year freedom from root reoperation was 81 +/- 6%, and from full root replacement was 94 +/- 2%. CONCLUSION: With increasing follow up after the Ross operation, the incidences of root dilatation and reoperation are likely to rise. Graft replacement of coexisting aneurysm, avoidance of root replacement technique and the use of root-stabilization measures may reduce the prevalence of late root pathology. Early replacement of dilated autograft roots may allow preservation of the autologous pulmonary valve.
Giovanni Battista Luciani; Alessandro Favaro; Gianluca Casali; Francesco Santini; Alessandro Mazzucco
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  14     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-12-19     Completed Date:  2006-02-21     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  766-72; discussion 772-3     Citation Subset:  IM    
Division of Cardiac Surgery, University of Verona, Italy.
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MeSH Terms
Aorta / pathology
Aortic Aneurysm / etiology,  surgery*
Aortic Valve / surgery*
Dilatation, Pathologic
Heart Valve Diseases / surgery*
Pulmonary Valve / transplantation*
Transplantation, Autologous

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