1887
Volume 2013, Issue 4
  • ISSN: 2305-7823
  • E-ISSN:

Abstract

To report our experience with the Ross operation in patients with predominant aortic stenosis (AS) using an inclusion cylinder (IC) method. Out of 324 adults undergoing a Ross operation, 204 patients of mean age of 41.3 years (limits 16–62) underwent this procedure for either AS or mixed AS and regurgitation (AS/AR) between October, 1992 and February, 2012, implanting the PA with an IC method. Clinical follow up and serial echo data for this group is 97% complete with late mortality follow up 99% complete. There has been zero (0%) early mortality, and late survival at 15 years is 98% (96%, 100%). Only one re-operation on the aortic valve for progressive aortic regurgitation (AR) has been required with freedom from re-operation on the aortic valve at 15 years being 99% (96%, 100%). The freedom from all re-operations on the aortic and pulmonary valves at 15 years is 97% (94%, 100%). Echo analysis at the most recent study shows that 98% have nil, trivial or mild AR. Aortic root size has remained stable, shown by long-term (15 year) echo follow up. In an experience spanning 19 years, the Ross operation used for predominant AS using the IC method described, results in 99% freedom from re-operation on the aortic valve at 15 years, better than any other tissue or mechanical valve. For adults under 65 years without significant co-morbidities who present with predominant AS, the pulmonary autograft inserted with this technique gives excellent results.

Loading

Article metrics loading...

/content/journals/10.5339/gcsp.2013.46
2014-01-01
2019-08-17
Loading full text...

Full text loading...

/deliver/fulltext/gcsp/2013/4/gcsp.2013.46.html?itemId=/content/journals/10.5339/gcsp.2013.46&mimeType=html&fmt=ahah

References

  1. [1]. Puvimanasinghe   JP., , Takkenberg   JJ., , Eijkemans   MJ., , Steyerberg   EW., , van Herwerden   LA., , Grunkemeier   GL., , Habbema   JD., , Bogers   AJ. . Prognosis after aortic valve replacement with the Carpentier-Edwards pericardial valve: use of microsimulation. . Ann Thorac Surg . 2005; ;80: : 825– 831 .
    [Google Scholar]
  2. [2]. El-Hamamsy   I., , Eryigit   Z., , Stevens   LM., , Sarang   Z., , George   R., , Clark   L., , Melina   G., , Takkenberg   JJ., , Yacoub   MH. . Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. . Lancet . 2010; ;376: : 524– 531 .
    [Google Scholar]
  3. [3]. David   TE., , Puschmann   R., , Ivanov   J., , Bos   J., , Armstrong   S., , Feindel   CM., , Scully   HE. . Aortic valve replacement with stentless and stented porcine valves: a case-match study. . J Thorac Cardiovasc Surg . 1998; ;116: : 236– 241 .
    [Google Scholar]
  4. [4]. O'Brien   MF., , Stafford   EG., , Gardner   MA., , Pohlner   PG., , Tesar   PJ., , Cochrane   AD., , Mau   TK., , Gall   KL., , Smith   SE. . Allograft aortic valve replacement: long-term follow-up. . Ann Thorac Surg . 1995; ;60: : S65– S70 .
    [Google Scholar]
  5. [5]. Oury   JH., , Doty   DB., , Oswalt   JD., , Knapp   JF., , Mackey   SK., , Duran   CM. . Cardiopulmonary response to maximal exercise in young athletes following the Ross procedure. . Ann Thorac Surg . 1998; ;66: : S153– S154 .
    [Google Scholar]
  6. [6]. Porter   GF., , Skillington   PD., , Bjorksten   AR., , Morgan   JG., , Yapanis   AG., , Grigg   LE. . Exercise hemodynamic performance of the pulmonary autograft following the Ross procedure. . J Heart Valve Dis . 1999; ;8: : 516– 521 .
    [Google Scholar]
  7. [7]. Yacoub   MH., , Klieverik   LM., , Melina   G., , Yacoub   MH., , Klieverik   LM., , Melina   G., , Edwards   SE., , Sarathchandra   P., , Bogers   AJ., , Squarcia   U., , Sani   G., , van Herwerden   LA., , Takkenberg   JJ. . An evaluation of the Ross operation in adults. . J Heart Valve Dis . 2006; ;15: : 531– 539 .
    [Google Scholar]
  8. [8]. Brown   JW., , Ruzmetov   M., , Shahriari   A., , Rodefeld   MD., , Mahomed   Y., , Turrentine   MW. . Midterm results of Ross aortic valve replacement: a single-institution experience. . Ann Thorac Surg . 2009; ;88: : 601– 607 , discussion 607–8 .
    [Google Scholar]
  9. [9]. Sievers   HH., , Hanke   T., , Stierle   U., , Bechtel   MF., , Graf   B., , Robinson   DR., , Ross   DN. . A critical reappraisal of the Ross operation: renaissance of the subcoronary implantation technique?.   Circulation . 2006; ;114: : I504– I511 .
    [Google Scholar]
  10. [10]. David   TE., , Woo   A., , Armstrong   S., , Maganti   M. . When is the Ross operation a good option to treat aortic valve disease?.   J Thorac Cardiovasc Surg . 2010; ;139: : 68– 73 , discussion 73–5 .
    [Google Scholar]
  11. [11]. Sievers   HH., , Stierle   U., , Charitos   EI., , Hanke   T., , Gorski   A., , Misfeld   M., , Bechtel   M. . Fourteen years' experience with 501 subcoronary Ross procedures: surgical details and results. . J Thorac Cardiovasc Surg . 2010; ;140: : 816– 822 , 822 e1–5 .
    [Google Scholar]
  12. [12]. Elkins   RC., , Thompson   DM., , Lane   MM., , Elkins   CC., , Peyton   MD. . Ross operation: 16-year experience. . J Thorac Cardiovasc Surg . 2008; ;136: : 623– 630 , 630 e1–5 .
    [Google Scholar]
  13. [13]. Klieverik   LM., , Takkenberg   JJ., , Bekkers   JA., , Roos-Hesselink   JW., , Witsenburg   M., , Bogers   AJ. . The Ross operation: a Trojan horse?.   Eur Heart J . 2007; ;28: : 1993– 2000 .
    [Google Scholar]
  14. [14]. Frigiola   A., , Ranucci   M., , Carlucci   C., , Giamberti   A., , Abella   R., , Di Donato   M. . The Ross procedure in adults: long-term follow-up and echocardiographic changes leading to pulmonary autograft reoperation. . Ann Thorac Surg . 2008; ;86: : 482– 489 .
    [Google Scholar]
  15. [15]. Hanke   T., , Stierle   U., , Boehm   JO., , Botha   CA., , Matthias Bechtel   JF., , Erasmi   A., , Misfeld   M., , Hemmer   W., , Rein   JG., , Robinson   DR., , Lange   R., , Hörer   J., , Moritz   A., , Ozaslan   F., , Wahlers   T., , Franke   UF., , Hetzer   R., , Hübler   M., , Ziemer   G., , Graf   B., , Ross   DN., , Sievers   HH., , German Ross Registry. . Autograft regurgitation and aortic root dimensions after the Ross procedure: the German Ross Registry experience. . Circulation . 2007; ;116: : I251– I258 .
    [Google Scholar]
  16. [16]. Juthier   F., , Banfi   C., , Vincentelli   A., , Ennezat   PV., , Le Tourneau   T., , Pinçon   C., , Prat   A. . Modified Ross operation with reinforcement of the pulmonary autograft: Six-year results. . J Thorac Cardiovasc Surg . 2010; ;139: : 1420– 1423 .
    [Google Scholar]
  17. [17]. Slater   M., , Shen   I., , Welke   K., , Komanapalli   C., , Ungerleider   R. . Modification to the Ross procedure to prevent autograft dilatation. . Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu . 2005; ; 181– 184 .
    [Google Scholar]
  18. [18]. Koul   B., , Al-Rashidi   F., , Bhat   M., , Meurling   C. . A modified Ross operation to prevent pulmonary autograft dilatation. . Eur J Cardiothorac Surg . 2007; ;31: : 127– 128 .
    [Google Scholar]
  19. [19]. Skillington   PD., , Fuller   JA., , Grigg   LE., , Yapanis   AG., , Porter   GF. . Ross procedure. Inserting the autograft using a fully supported root replacement method; techniques and results. . J Heart Valve Dis . 1999; ;8: : 593– 600 .
    [Google Scholar]
  20. [20]. Skillington   PD., , Grigg   LE. . Insertion of the pulmonary autograft as an inclusion cylinder–modifications to existing techniques. . J Heart Valve Dis . 1995; ;4: : 374– 378 .
    [Google Scholar]
  21. [21]. Elkins   RC., , Santangelo   K., , Stelzer   P., , Randolph   JD., , Knott-Craig   CJ. . Pulmonary autograft replacement of the aortic valve: an evolution of technique. . J Card Surg . 1992; ;7: : 108– 116 .
    [Google Scholar]
  22. [22]. Pacifico   AD., , Kirklin   JK., , McGiffin   DC., , Matter   GJ., , Nanda   NC., , Diethelm   AG. . The Ross operation–early echocardiographic comparison of different operative techniques. . J Heart Valve Dis . 1994; ;3: : 365– 370 .
    [Google Scholar]
  23. [23]. Collett   D. . Modelling Survival Data in Medical Research . London: : Chapman and Hall;   1994; ; : 22– 26 .
    [Google Scholar]
  24. [24]. Blackstone   EH., , Rajeswaran   J. . A non-linear cumulative logit mixed model with time varying phases and coefficients. . Conference proceedings, XXIII International Biometric Conference, Montreal, Canada 2006 .
    [Google Scholar]
  25. [25]. Gillinov   AM., , McCarthy   PM., , Blackstone   EH., , Rajeswaran   J., , Pettersson   G., , Sabik   JF., , Svensson   LG., , Cosgrove   DM., , Hill   KM., , Gonzalez-Stawinski   GV., , Marrouche   N., , Natale   A. . Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality. . J Thorac Cardiovasc Surg . 2005; ;129: : 1322– 1329 .
    [Google Scholar]
  26. [26]. Blackstone   EH. . Breaking down barriers: helpful breakthrough statistical methods you need to understand better. . J Thorac Cardiovasc Surg . 2001; ;122: : 430– 439 .
    [Google Scholar]
  27. [27]. Diggle   PJ., , Heagerty   PJ., , Liang   KY., , Zeger   SL. . Analysis of longitudinal data . 2nd ed.   New York: : Oxford University Press;   2002; .
    [Google Scholar]
  28. [28]. Mason   DP., , Rajeswaran   J., , Murthy   SC., , McNeill   AM., , Budev   MM., , Mehta   AC., , Pettersson   GB., , Blackstone   EH. . Spirometry after transplantation: how much better are two lungs than one?.   Ann Thorac Surg . 2008; ;85: : 1193– 1201 , 1201 e1–2 .
    [Google Scholar]
  29. [29]. Breiman   L. . Bagging predictors. . Mach Learn . 1996; ;24: : 123– 140 .
    [Google Scholar]
  30. [30]. Efron   B., , Tibshirani   RJ. . An introduction to the bootstrap . New York: : Chapman and Hall/CRC;   1998; .
    [Google Scholar]
  31. [31]. Kvidal   P., , Bergstrom   R., , Horte   LG., , Stahle   E. . Observed and relative survival after aortic valve replacement. . J Am Coll Cardiol . 2000; ;35: : 747– 756 .
    [Google Scholar]
  32. [32]. Zellner   JL., , Kratz   JM., , Crumbley   AJ 3rd., , Stroud   MR., , Bradley   SM., , Sade   RM., , Crawford   FA Jr. . Long-term experience with the St. Jude Medical valve prosthesis. . Ann Thorac Surg . 1999; ;68: : 1210– 1218 .
    [Google Scholar]
  33. [33]. Butchart   EG., , Li   HH., , Payne   N., , Buchan   K., , Grunkemeier   GL. . Twenty years' experience with the Medtronic Hall valve. . J Thorac Cardiovasc Surg . 2001; ;121: : 1090– 1100 .
    [Google Scholar]
  34. [34]. Lund   O., , Nielsen   SL., , Arildsen   H., , Ilkjaer   LB., , Pilegaard   HK. . Standard aortic St. Jude valve at 18 years: performance profile and determinants of outcome. . Ann Thorac Surg . 2000; ;69: : 1459– 1465 .
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/gcsp.2013.46
Loading
/content/journals/10.5339/gcsp.2013.46
Loading

Data & Media loading...

Supplementary File 1

  • Article Type: Research Article
Keyword(s): aortic valve , valve stenosis and valve surgery
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error