Document Detail


Thirteen years' experience with the Ross Operation.
MedLine Citation:
PMID:  19301558     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate 13 years' results of the Ross operation, with special attention paid to the late function of the pulmonary autograft (PA) and the right ventricular outflow tract (RVOT) allograft, in an attempt to identify risk factors that might significantly influence their late performance. METHODS: Between May 1995 and March 2006, a total of 272 patients (mean age 30 +/- 11 years) was submitted to a Ross operation at the authors' institution. The most prevalent etiology was rheumatic disease (47%). The PA was implanted as a root replacement in 236 cases, and as an intraluminal cylinder in 36. The RVOT was reconstructed with a cryopreserved allograft in conventional fashion (n=142), with a proximal extension of the allograft with pericardium (n=46), with an allograft decellularized with deoxycholic acid (n=39), or an allograft decellularized with sodium dodecylsulfate (SDS) (n=44). The mean follow up was 67 months (range: 1-153 months: the total follow up was 1,525 patient-years. RESULTS: Hospital mortality was 2.9% and late survival 93% at 12 years. There were two episodes of cerebral thromboembolism, and six patients developed bacterial endocarditis. Sixteen patients required reoperation for problems involving the PA and/or the RVOT allograft, progression of rheumatic mitral valve disease and iatrogenic coronary insufficiency. After 12 years, 97% and 95% of patients were free from reoperation with the PA and allograft, respectively. Over time, the PA showed increasing dimensions, and 10 patients had a diameter >45 mm. Univariate analysis revealed degenerative disease and aortic annulus >25 mm as significant risk factors for late PA dilatation. Female gender and bicuspid aortic valve were borderline factors for this type of complication. Another 14 patients had late moderate PA insufficiency, and this was correlated with a preoperative diagnosis of aortic insufficiency. Reconstruction of the RVOT with allografts decellularized with SDS were associated with lower gradients at late follow up. CONCLUSION: Late results with the Ross operation were associated with excellent long-term survival and a low incidence of reoperations up to 13 years. Due to late PA dilatation and/or progressive valvar insufficiency, some reoperations may be expected with a longer follow up. For the RVOT reconstruction, the use of decellularized allografts with SDS may prove to be a good alternative to RVOT reconstruction.
Authors:
Francisco D A da Costa; Lúcia R Santos; Claudinei Collatusso; Camila N Matsuda; Sérgio A V Lopes; Sanderson Cauduro; João G Roderjan; Eileen Ingham
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  18     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-03-23     Completed Date:  2009-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  84-94     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery of Santa Casa de Curitiba, PUCPR, Curitiba, Paraná, Brazil. fcosta13@mac.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aortic Valve / surgery*
Cardiac Surgical Procedures / mortality
Disease Progression
Female
Heart Valve Diseases / mortality,  physiopathology,  surgery*
Humans
Male
Postoperative Complications
Pulmonary Valve / transplantation*
Reoperation
Rheumatic Heart Disease / complications
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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