PMID- 20353892
OWN - NLM
STAT- MEDLINE
DCOM- 20110512
LR  - 20100823
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 38
IP  - 3
DP  - 2010 Sep
TI  - Preservation of the pulmonary autograft after failure of the Ross procedure.
PG  - 326-32
LID - 10.1016/j.ejcts.2010.02.014 [doi]
AB  - OBJECTIVE: Failure of the pulmonary autograft following the Ross Procedure is 
      mainly due to dilatation and/or cusp prolapse causing insufficiency. We analysed 
      the result of pulmonary autograft valve sparing and repair, using techniques 
      developed for native aortic root and valve. METHODS: Of a total of 275 patients 
      who underwent Ross operation between 1991 and 2009, 31 needed autograft 
      re-operation. Of the 28 patients re-operated in our centre, 26 (93%) had 
      autograft valve preservation and they represent the study cohort. At the initial 
      Ross procedure, root remplacement technique was performed in 20 patients and 
      autograft inclusion technique was performed in 6. Mean redo interval was 9.3 + or 
      - 3.5 years and mean age at redo was 44 + or - 13 years. Indications for 
      re-operations were neo-aorta dilatation (n=12; 46%), autograft insufficiency 
      (n=4; 15%) and dilatation with autograft insufficiency (n=10; 40%). Neo-aorta 
      dilatation was repaired using valve-sparing root replacement (n=12, 46%) or 
      ascending aorta replacement (n=10; 40%). Cusp prolapse was repaired by 
      commissural re-suspension (n=1), free margin plication (n=10) or re-suspension 
      with polytetrafluoroethylene (PTFE; n=6). Cusp repair was performed in isolation 
      (n=4) or in association with sparing (n=5) or ascending aorta replacement (n=4). 
      RESULTS: There was no in-hospital mortality. Two patients having undergone 
      isolated cusp repair needed valve replacement for recurrent insufficiency after 5 
      days and 8 years postoperatively. At follow-up (100% complete, median: 27 months) 
      all patients were alive, in New York Heart Association (NYHA) class I (n=22; 84%) 
      or II (n=4; 16%). No autograft regurgitation was present in nine patients (five 
      sparing and four ascending aorta replacement); grade I insufficiency was present 
      in 11 (six sparing and five ascending aorta replacement), grade 2 in two (one 
      sparing and one isolated cusp repair) and grade 3 in two (one ascending aorta 
      replacement and one isolated cusp repair). At 3 years, overall freedom from 
      autograft insufficiency > or = grade 3 was 80%. CONCLUSION: Preservation of the 
      pulmonary autograft valve can be safely performed in selected patients. At 
      midterm, repair of neo-aorta dilatation using valve-sparing root replacement or 
      ascending aorta replacement showed acceptable results. In contrast, results of 
      cusp repair for isolated autograft insufficiency were unsatisfactory.
CI  - Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - de Kerchove, Laurent
AU  - de Kerchove L
AD  - Divisions of Cardiothoracic and Vascular Surgery, Universite Catholique de 
      Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 
      Laurent.dekerchove@uclouvain.be
FAU - Boodhwani, Munir
AU  - Boodhwani M
FAU - Etienne, Pierre-Yves
AU  - Etienne PY
FAU - Poncelet, Alain
AU  - Poncelet A
FAU - Glineur, David
AU  - Glineur D
FAU - Noirhomme, Philippe
AU  - Noirhomme P
FAU - Rubay, Jean
AU  - Rubay J
FAU - El Khoury, Gebrine
AU  - El Khoury G
LA  - eng
PT  - Journal Article
DEP - 20100328
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adult
MH  - Aortic Valve/*surgery
MH  - Aortic Valve Insufficiency/surgery
MH  - Aortic Valve Stenosis/surgery
MH  - Epidemiologic Methods
MH  - Female
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care/methods
MH  - Pulmonary Valve/*transplantation
MH  - Recurrence
MH  - Reoperation/methods
MH  - Treatment Failure
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2010/04/01 06:00
MHDA- 2011/05/13 06:00
CRDT- 2010/04/01 06:00
PHST- 2009/09/30 00:00 [received]
PHST- 2010/01/29 00:00 [revised]
PHST- 2010/02/01 00:00 [accepted]
PHST- 2010/04/01 06:00 [entrez]
PHST- 2010/04/01 06:00 [pubmed]
PHST- 2011/05/13 06:00 [medline]
AID - S1010-7940(10)00156-9 [pii]
AID - 10.1016/j.ejcts.2010.02.014 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2010 Sep;38(3):326-32. doi: 10.1016/j.ejcts.2010.02.014. 
      Epub 2010 Mar 28.