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Review article: Biomedical intelligence

Vol. 142 No. 2930 (2012)

The Ross procedure for everyone

  • Denis Berdajs
DOI
https://doi.org/10.4414/smw.2012.13641
Cite this as:
Swiss Med Wkly. 2012;142:w13641
Published
15.07.2012

Summary

Aortic valve replacement using a pulmonary homograft is a complex procedure which provides very good functional results in most patients. Negligible valve-related morbidity, freedom from anticoagulation, and the ability to accommodate growth make it a valid therapeutic modality in infants and children. Due to the excellent quality of life which it provides, the procedure is increasingly being performed in adults. However, it has become apparent that pulmonary homograft insufficiency may be a relatively common problem. Dilatation of the pulmonary autograft is the most common complication after a Ross procedure affecting nearly one-third of patients. It was suggested that dilatation of the pulmonary autograft occurs because of a geometric mismatch between the aortic and pulmonary roots. Despite there been no morphological or physiological data, the authors believed that spatial geometry may influence the dilatation of the neo-aortic root.

Herein, I analyse the actual literature stressing long-term results and predictive factors for neo-aorta failure following the Ross procedure. According to my previous morphological investigations I made a proposition of how the Ross procedure may be modified in order to include it for everyone as an aortic valve substitute.

References

  1. Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Circulation. 2006;114(5):e84–231.
  2. Akins CW, Buckley MJ, Daggett WM, et al. Risk of reoperative valve replacement for failed mitral and aortic bioprostheses. Ann Thorac Surg. 1998;65:1545.
  3. Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36:1152.
  4. Gallo I, Ruiz B, Duran CM. Clinical experience with the Carpentier-Edwards porcine bioprosthesis: Short-term results (from 2 to 4.5 years). Thorac Cardiovasc Surg. 1983;31:277.
  5. Elkins RC, Lane MM, McCue C. Pulmonary autograft reoperation: incidence and management. Ann Thorac Surg. 1996;62:450.
  6. Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet. 1967;4:2:956–8.
  7. Stelzer P, Jones DJ, Elkins RC. Aortic root replacement with pulmonary autograft. Circulation. 1989;80(pt 2):III-209–III-213.
  8. Ross D, Jackson M, Davies J. Pulmonary autograft aortic valve replacement: long-term results. J Card Surg. 1991;6:529.
  9. Kouchoukos NT, Masetti P, Nickerson NJ, Castner CF, Shannon WD, Dávila-Román VG. The Ross procedure: long-term clinical and echocardiographic follow-up. Ann Thorac Surg. 2004;78:773–81.
  10. Takkenberg JJM, Klieverik LMA, Schoof PH, van Suylen RJ, van Herwerden LA, Zondervan PE, et al. The Ross procedure: a systematic review and meta-analysis. Circulation. 2009;119:222–8.
  11. Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16-year experience. J Thorac Cardiovasc Surg. 2008;136:623–30.
  12. David TE, Omran A, Ivanov J, et al. Dilation of the pulmonary autograft after the Ross procedure. J Thorac Cardiovasc Surg. 2000;119:210.
  13. Pasquali SK, Cohen MS, Shera D, Wernovsky G, Spray TL, Marino BS. The relationship between neo-aortic root dilation, insufficiency, and reintervention following the Ross procedure in infants, children, and young adults. J Am Coll Cardiol. 2007;49:1806–12.
  14. David TE, Omran A, Webb G, Rakowski H, Armstrong S, Sun Z. Geometrical mismatch of the aortic and pulmonary roots causes aortic insufficiency after the Ross procedure. J Thorac Cardiovascular Surg. 1996;112:1231–9.
  15. Lansac E, Lim HS, Shomura Y, et al. Aortic and pulmonary root: are their dynamics similar? Eur J Cardiothorac Surg. 2002;21:268–75.
  16. Berdajs D, Turina MI; Operative Anatomy of the Heart Springer Verlag 2011; p 246–251, p; 359–362.
  17. Berdajs D, Zünd G, Schurr U, Camenisch C, Turina MI, Genoni M. Geometric models of the aortic and pulmonary roots: suggestions for the Ross procedure. Eur J Cardiothorac Surg. 2007;31(1):31–5. Epub 2006 Nov 28.
  18. Berdajs D, Patonay D, Zünd G, Turina MI. Geometrical model of the pulmonary root. J Heart Valve Disease. 2005;14(2):257–60.
  19. Berdajs D, Patonay L, Turina M. Clinical anatomy of the aortic root: Cardiovasc Surg. 2002;10(4):320–7.