PMID- 10193986
OWN - NLM
STAT- MEDLINE
DCOM- 19990616
LR  - 20190921
IS  - 0886-0440 (Print)
IS  - 0886-0440 (Linking)
VI  - 13
IP  - 3
DP  - 1998 May
TI  - Aortic pulmonary autograft implant: medium-term follow-up with a note on a new 
      right ventricular pulmonary artery conduit.
PG  - 173-6
AB  - BACKGROUND: The Ross operation has been applied to various aortic valve 
      pathologies, particularly when somatic growth is an issue. However, associated 
      cardiac disease and technical problems may limit its use with regard to 
      associated procedures and issues of right ventricular outflow reconstruction. 
      MATERIALS AND METHODS: From December 1992 to March 1998, 24 patients underwent 
      aortic pulmonary autograft implantation. There were 14 males and 10 females, 
      15+/-10 years of age (mean +/- SD) (range 1 to 50 years), weighing 42.8+/-20 kg 
      (mean +/- SD) (range 8 to 78 kg). Aortic insufficiency was present in 15 (62.5%) 
      patients, stenosis in 8 (33.3%) patients, and valvar stenosis associated with 
      left ventricular outflow tract obstruction in 1 (4.1%) patient. Etiology was 
      rheumatic in 17 patients and congenital in 7. The Ross procedure was accompanied 
      by a partial-Konno left ventricular outflow enlargement in one patient, and 
      mitral valve annuloplasty, mitral commissurotomy, and tricuspid valve replacement 
      in three other patients, respectively. The right ventricular outflow was 
      reconstructed with a valved pulmonary homograft in 14 patients and with a 
      Shelhigh No-React porcine pulmonary conduit in 10 patients. Evaluation was done 
      by New York Heart Association (NYHA) Class and by echocardiography at a follow-up 
      of 22.8+/-24 months (mean +/- SD) (range 3 to 63 months). RESULTS: There were no 
      operative mortalities and no postoperative arrhythmias. One (4.1%) patient 
      required intra-aortic balloon pump (IABP) support for 3 days, one (4.1%) patient 
      died 2 years later of probable arrhythmia, and one (4.1%) patient required 
      mechanical aortic valve replacement 2 years later for severe autograft 
      insufficiency. Left ventricular ejection fraction was unchanged (preoperative 
      62.4%+/-30%, postoperative 64.2%+/-30% [mean +/- SD], [p = NS]) and no 
      significant gradient was documented by echocardiographic Doppler in the right and 
      left ventricular outflow tracts. The aortic insufficiency scale decreased from a 
      mean of 3.9+/-0.2 to a mean of 1+/-0 (p < 0.01). NYHA Class decreased to I in all 
      patients, from III (10) and II (14). CONCLUSIONS: The pulmonary autograft in the 
      aortic position is suitable for aortic valve replacement in pediatric and adult 
      patients with good medium-term results and in patients with rheumatic etiology, 
      and it provides a desirable solution in the presence of associated pathologies, 
      such as left ventricular tract obstruction or associated multivalvular disease. 
      The development of new means of right ventricular outflow reconstruction must 
      parallel the progress achieved for the left side.
FAU - Masetti, P
AU  - Masetti P
AD  - The Department of Cardiac Surgery Hesperia Hospital, Modena, Italy.
FAU - Ussia, G P
AU  - Ussia GP
FAU - Gazzolo, D
AU  - Gazzolo D
FAU - Marianeschi, S M
AU  - Marianeschi SM
FAU - Abella, R F
AU  - Abella RF
FAU - Cipriani, A
AU  - Cipriani A
FAU - Labia, C
AU  - Labia C
FAU - Iorio, F S
AU  - Iorio FS
FAU - Marcelletti, C F
AU  - Marcelletti CF
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aortic Valve/*surgery
MH  - Aortic Valve Stenosis/complications/diagnostic imaging/*surgery
MH  - Blood Vessel Prosthesis Implantation/*methods
MH  - Cardiac Output
MH  - Child
MH  - Child, Preschool
MH  - Echocardiography, Doppler
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications
MH  - Pulmonary Artery/*surgery
MH  - Pulmonary Valve/*transplantation
MH  - Retrospective Studies
MH  - Transplantation, Autologous
MH  - Treatment Outcome
MH  - Ventricular Outflow Obstruction/complications/diagnostic imaging/surgery
EDAT- 1999/04/08 00:00
MHDA- 1999/04/08 00:01
CRDT- 1999/04/08 00:00
PHST- 1999/04/08 00:00 [pubmed]
PHST- 1999/04/08 00:01 [medline]
PHST- 1999/04/08 00:00 [entrez]
AID - 10.1111/j.1540-8191.1998.tb01257.x [doi]
PST - ppublish
SO  - J Card Surg. 1998 May;13(3):173-6. doi: 10.1111/j.1540-8191.1998.tb01257.x.