Document Detail


The fate of the pulmonary autograft in the aortic position: experience and results of 98 patients in twelve years.
MedLine Citation:
PMID:  20824585     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The ideal prosthesis for aortic valve replacement in infants and adolescents is still controversially discussed. Implantation of mechanical prostheses or homografts is associated with serious risks such as reoperations, thromboembolic events and infections. This has led many surgeons to prefer the Ross operation.
METHODS: Between 1996 and 2008 we performed Ross operations in 98 children and infants with a mean age of 11 years (range 1 mo-25 y), including concomitant procedures (n = 33). The operation was performed as a full-root replacement in 97 and as a subcoronary implantation in one patient. The patients were followed for up to twelve years (follow-up complete) to determine clinical and echocardiographic parameters. Mean duration of follow-up was 60 +/- 37 (range 3-150 months).
RESULTS: Overall survival was 98 % (n = 96). In 70 patients (71.4 %) no autograft insufficiency (AI) could be observed. AI grade I was present in 22 patients (22.4 %), AI grade II in 3 patients (3 %), and AI grade III in one patient. The autograft in the latter patient was replaced by a mechanical prosthesis. Aortic root dilatation was observed in 10 patients (10.2 %). Z-score (median) in these patients was 4.1 (normal z-score < or = 2.4). One patient with aortic root dilatation was reoperated. A pacemaker was implanted in two patients. No patient is on constant anticoagulants.
CONCLUSION: The anatomy and physiology of the LVOT is best restored by the implantation of a pulmonary autograft. This additionally provides a growth potential for infants at low risk for reoperations. Autograft dilatation is a risk that requires constant evaluation.
Authors:
K Valeske; M Müller; N Hijjeh; J Bauer; A Böning; D Schranz; H Akintürk
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Publication Detail:
Type:  Journal Article     Date:  2010-09-07
Journal Detail:
Title:  The Thoracic and cardiovascular surgeon     Volume:  58     ISSN:  1439-1902     ISO Abbreviation:  Thorac Cardiovasc Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-08     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903387     Medline TA:  Thorac Cardiovasc Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  334-8     Citation Subset:  IM    
Copyright Information:
Georg Thieme Verlag KG Stuttgart, New York.
Affiliation:
Children's Heart Center and Cardiovascular Surgery, University Giessen/Marburg, Giessen, Germany. Klaus.Valeske@chiru.med.uni-giessen.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aortic Aneurysm / etiology,  surgery
Aortic Valve / surgery*,  ultrasonography
Bioprosthesis*
Child
Child, Preschool
Disease-Free Survival
Echocardiography, Doppler
Female
Germany
Graft Survival
Heart Defects, Congenital / mortality,  surgery*,  ultrasonography
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation* / adverse effects,  mortality
Humans
Infant
Kaplan-Meier Estimate
Male
Pulmonary Artery / transplantation*
Reoperation
Risk Assessment
Time Factors
Transplantation, Autologous
Treatment Outcome
Young Adult

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


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