Complex valvular procedures: ross, mitral, redos--time enough?

The possibility of a lengthy ischemic time is considered when evaluating complex valvular procedures. This consideration or even worry may influence the choice of valve replacement, repair offered, or actual acceptance of the case because of expected outcomes. With the use of an integrated, streamlined blood cardioplegic delivery, we believe these complex valvular procedures, even combined with revascularization, can be managed with good results. Additionally, this technique allows for sufficient protection to teach these same complex valvular repairs. A summary of a 10-year personal experience with the Ross procedure in 120 patients is covered. Aortic stenosis, insufficiency, and, particularly, infective endocarditis, have been managed with an overall surgical mortality rate of 2.5%. The endocarditis subset has a mortality of 0% with 100% cure of the infection. Data regarding complex mitral repairs and replacement are likewise included.