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Update on the mitral pulmonary autograft.

Sami S Kabbani1, Nada A Sabbagh, Abir Y Kudsi

  • 1Damascus University Cardiovascular Surgical Center Mezzah, Damascus, Syria. dam-uncv@net.sy

Asian Cardiovascular & Thoracic Annals
|September 3, 2011
PubMed
Summary

The Ross II procedure using pulmonary autografts for mitral valve replacement shows excellent long-term results, with high freedom from reoperation and structural valve deterioration. This surgical option is suitable for younger patients and infants with complex valve disease.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Thoracic Surgery

Background:

  • Mitral valve disease often requires replacement, with various prosthetic options available.
  • The pulmonary autograft (Ross II procedure) offers a biological alternative for mitral valve replacement.
  • Long-term outcomes of the Ross II procedure for mitral valve replacement are crucial for patient selection.

Purpose of the Study:

  • To update and present long-term follow-up data for patients who underwent mitral valve replacement using the Ross II procedure.
  • To evaluate the efficacy and durability of pulmonary autografts in the mitral position.

Main Methods:

  • A cohort of 92 patients with irreparable mitral valves underwent replacement with pulmonary autografts between July 1997 and August 2004.
  • Follow-up data were collected for a mean period of 94 months.

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  • Transesophageal echocardiography was used for immediate post-operative assessment.

    • Main Results:

    • Eighty-eight patients had a successful Ross II operation; 4 were lost to follow-up.
    • Operative mortality was 4.6%, and late mortality related to the operation was 12.5%.
    • At a mean follow-up of 94 months, freedom from structural valve deterioration was 93.4%, freedom from reoperation was 92.0%, and freedom from all-cause death was 82.9%.

    Conclusions:

    • The Ross II procedure for mitral valve replacement demonstrates favorable long-term outcomes, comparable to modern bioprostheses.
    • This procedure is a viable option for younger patients and infants with complex mitral valve disease, especially when anticoagulation is a concern.
    • Pulmonary autograft durability and low rates of reoperation support its continued consideration in selected patient populations.