Document Detail


Spectrum and outcome of reoperations after the Ross procedure.
MedLine Citation:
PMID:  20823390     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Proposed advantages to the Ross procedure included presumed increased freedom from reoperation and simpler reoperation for pulmonary conduit replacement if needed. It is increasingly apparent, however, that reoperations are frequent after the Ross procedure and that when required, they may be more complex than previously thought. METHODS AND RESULTS: Between September 1991 and August 2008, 56 patients underwent reoperation at our institution after a Ross procedure performed by ourselves (n=13) or elsewhere (n=43). Median age at first reoperation at our institution was 26 years (range 1 to 69 years). The 4 most common indications for reoperation were isolated autograft (neoaortic) regurgitation in 11 cases (20), isolated pulmonary conduit regurgitation/stenosis in 9 (16), combined autograft regurgitation/dilatation in 8 (14), and combined autograft regurgitation and pulmonary conduit regurgitation/stenosis in 6 (11). A total of 144 procedures were performed in these 56 patients during first reoperation at our institution. The autograft valve required replacement in 21 cases (38) and aortic root replacement in 21 (38), with ascending aortic/arch reconstruction in 13 (23) and mitral valve surgery in 5 (9). The pulmonary valve was replaced in 33 cases (59) and the tricuspid valve was repaired/replaced in 10 (18). Early mortality was 1.8 (1 of 56 patients), and morbidity included 6 patients with respiratory failure and 3 who required postcardiotomy extracorporeal membrane oxygenation. There were 4 late deaths during the median follow-up of 8 months (range 1 to 179 months). CONCLUSIONS: A broad spectrum of complex reoperations may be required after the Ross procedure. Patients and family members considering the procedure should be informed of the potential for associated morbidity should reoperation be necessary.
Authors:
John M Stulak; Harold M Burkhart; Thoralf M Sundt; Heidi M Connolly; Rakesh M Suri; Hartzell V Schaff; Joseph A Dearani
Publication Detail:
Type:  Journal Article     Date:  2010-09-07
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-21     Completed Date:  2010-10-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1153-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aortic Valve / physiopathology,  surgery*
Aortic Valve Insufficiency / physiopathology,  surgery
Cardiovascular Surgical Procedures / methods*
Child
Child, Preschool
Echocardiography
Heart Valve Diseases / mortality,  physiopathology,  surgery*
Humans
Infant
Middle Aged
Mitral Valve / physiopathology,  surgery*
Pulmonary Valve / physiopathology,  surgery*
Reoperation
Retrospective Studies
Survival Rate
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Circulation. 2010 Sep 21;122(12):1139-40   [PMID:  20823383 ]

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