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Mitral valve replacement with Ross II technique: initial experience.

John W Brown1, Mark Ruzmetov, Mark D Rodefeld

  • 1Section of Cardiothoracic Surgery, James W. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA. jobrown@iupui.edu

The Annals of Thoracic Surgery
|January 24, 2006
PubMed
Summary
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Pulmonary autograft mitral valve replacement (PA-MVR) offers a lifelong autologous option for selected patients, avoiding anticoagulation. However, aggressive treatment of hypertension is crucial to prevent autograft leaflet complications and reoperation.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair and Replacement
  • Thoracic Surgery

Background:

  • Pulmonary autograft mitral valve replacement (PA-MVR), introduced in 1967, has seen limited use in North America and Europe.
  • This study reviews early clinical experiences with the PA-MVR technique.

Purpose of the Study:

  • To evaluate the early outcomes and feasibility of Pulmonary Autograft Mitral Valve Replacement (PA-MVR).
  • To assess the potential of PA-MVR as a lifelong autologous valve solution.
  • To identify factors influencing the success and complications of PA-MVR.

Main Methods:

  • Eight patients (12-46 years) underwent PA-MVR for various mitral valve pathologies, including outgrown mechanical valves, failed repairs, and myxoid prolapse.
  • The pulmonary autograft was harvested, prepared within a Dacron graft, and covered with autologous pericardium.

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  • Intraoperative and follow-up echocardiography were used to assess valve function.

    • Main Results:

    • No operative mortality was observed.
    • Initial results showed good hemodynamics with trivial to mild regurgitation.
    • However, 3 out of 4 patients required reoperation within 6-14 months due to progressive regurgitation or gradient, particularly in those with systemic hypertension or severe myxoid degeneration.
    • One patient with mild-to-moderate regurgitation and controlled hypertension is under observation.

    Conclusions:

    • PA-MVR presents a potential lifelong autologous valve option, eliminating the need for anticoagulation in select patients.
    • Careful patient selection, especially younger individuals in sinus rhythm, is recommended.
    • Aggressive management of postoperative systemic hypertension is critical to prevent autograft stress and failure.