Pulmonary valve autotransplantation (the Ross operation)

Area of Science:

• Cardiovascular Surgery
• Transplantation Immunology
• Biomaterials Science

Background:

• Early homografts (1967) exhibited degeneration and calcification, limiting their long-term efficacy.
• Freeze-dried valves, while preserving tissue, lacked viability and showed signs of deterioration.
• Challenges in homograft procurement necessitated alternative strategies for aortic valve replacement.

Purpose of the Study:

• To evaluate the efficacy of cryopreservation for maintaining homograft viability and tissue integrity.
• To assess the outcomes of autologous pulmonic valve transfer to the aortic position, addressing procurement issues.
• To analyze operative mortality, reoperation rates, and primary tissue failure in patients undergoing this procedure.

Main Methods:

• Implementation of cryopreservation techniques in 1967 to preserve valve tissue.
• Surgical transfer of the patient's own pulmonic valve to the aortic position.
• Review of 249 operations performed over twenty years, analyzing mortality and reoperation data.

Main Results:

• Cryopreservation successfully preserved valve viability and tissue integrity.
• A total of 249 operations were performed with a 6.5% operative mortality rate (16 deaths).
• Notably, there were no operative deaths in the last ten years and no reported primary tissue failure in the aortic position; 14.4% (36 patients) required reoperation.

Conclusions:

• Cryopreservation is an effective method for preserving homograft quality.
• Autologous pulmonic valve transfer to the aortic position offers a viable alternative with improved safety and reduced long-term complications.
• The procedure demonstrates a favorable trend towards zero operative mortality and absence of primary tissue failure in recent years.