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The Ross procedure in adults: intermediate-term results
David A Fullerton1, James W Fredericksen, R Sudhir Sundaresan
1Division of Cardiothoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. dfullert@nmh.org
The Annals of Thoracic Surgery
|August 7, 2003
Summary
A standardized surgical approach to the Ross procedure, focusing on geometric matching of aortic and pulmonary roots, enhances the durability of this aortic valve replacement surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Valve Repair
Background:
- The long-term success of the Ross procedure relies on optimal geometric alignment between the aortic and pulmonary artery roots.
- Geometric mismatch can compromise the durability of the Ross procedure.
Purpose of the Study:
- To present a standardized surgical strategy for the Ross procedure.
- To minimize geometric mismatch during aortic root replacement.
Main Methods:
- The Ross procedure was performed as a root replacement, standardizing aortic annulus size to 23 mm with external buttressing.
- Synthetic interposition grafts and external buttressing were used to prevent distal anastomosis mismatch.
- An oversized pulmonary homograft (27-28 mm) was routinely employed for right ventricular outflow tract reconstruction.
Main Results:
- Forty-four patients underwent the procedure with a mean follow-up of 38 months.
- Aortic annular plication was performed in 93% of patients; 32% received an aortic interposition graft.
- Low rates of reoperation (1 patient), trivial autograft insufficiency, and no significant pulmonary homograft stenosis were observed.
Conclusions:
- A standardized surgical technique effectively achieves geometric matching of the aortic and pulmonary roots in the Ross procedure.
- This standardized approach has the potential to improve the long-term durability of the Ross operation.