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The Ross procedure using autologous support of the pulmonary autograft: techniques and late results

Skillington, Peter D., Mokhles, M. Mostafa, Takkenberg, Johanna J. M., Larobina, Marco, O'Keefe, Michael, Wynne, Rochelle and Tatoulis, James 2015, The Ross procedure using autologous support of the pulmonary autograft: techniques and late results, Journal of thoracic and cardiovascular surgery, vol. 149, no. 2 Suppl, pp. S46-S52, doi: 10.1016/j.jtcvs.2014.08.068.

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Title The Ross procedure using autologous support of the pulmonary autograft: techniques and late results
Author(s) Skillington, Peter D.
Mokhles, M. Mostafa
Takkenberg, Johanna J. M.
Larobina, Marco
O'Keefe, Michael
Wynne, Rochelle
Tatoulis, James
Journal name Journal of thoracic and cardiovascular surgery
Volume number 149
Issue number 2 Suppl
Start page S46
End page S52
Total pages 7
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2015-02
ISSN 0022-5223
1097-685X
Keyword(s) Adolescent
Adult
Aortic Aneurysm
Aortic Valve Insufficiency
Aortic Valve Stenosis
Autografts
Bioprosthesis
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Prosthesis Design
Pulmonary Artery
Pulmonary Valve
Reoperation
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Summary OBJECTIVES: It is hypothesized that by performing radical aortic root manipulation and then autologous support for the pulmonary autograft in the Ross procedure, this will maintain aortic root size and should, in turn, lead to the demonstrated low incidence of late aortic regurgitation and need for reoperation on the aortic root and valve.
METHODS: Aortic root size was measured echocardiographically both preoperatively and then at second yearly intervals in 322 consecutive patients who underwent a Ross operation between October 1992 and June 2013 with autologous support of the pulmonary autograft root using the patient's own aorta. This technique, a variant of the inclusion cylinder method, has been developed with the aim of minimizing prosthetic materials in the aortic root.
RESULTS: Measures to reduce aortic root size included annulus reduction in 201 patients (62.4%) and reduction in aortic sinus or sinotubular junction in 159 patients (49.4%). Maximal aortic root diameter postoperatively at 5, 10, and 15 years was 34.0, 34.6, and 34.7 mm, respectively. Eleven reoperations were required during the study period for progressive aortic regurgitation (none for aortic root enlargement), with freedom from reoperation being 96% at both 15 years and 18 years. Preoperative pure aortic regurgitation, aortic annulus, and sinotubular junction enlargement were risk factors for reoperation.
CONCLUSIONS: This inclusion method of pulmonary autograft implantation leads to minimal increases in aortic root size over time, with no reoperations for aortic root dilatation and a low requirement for aortic valve reoperation. The Ross procedure deserves to remain on the surgical menu for aortic valve replacement.
Language eng
DOI 10.1016/j.jtcvs.2014.08.068
Field of Research 110299 Cardiorespiratory Medicine and Haematology not elsewhere classified
1102 Cardiovascular Medicine And Haematology
1103 Clinical Sciences
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, The American Association for Thoracic Surgery
Persistent URL http://hdl.handle.net/10536/DRO/DU:30091719

Document type: Journal Article
Collection: School of Nursing and Midwifery
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