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A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
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Technical Modifications That Might Improve Long-term Outcomes of the Ross Procedure in Children
Luca A Vricella1, Chawki El-Zein2, Narutoshi Hibino1
1The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, Illinois; Department of Surgery, University of Chicago Medicine, Oak Lawn, Illinois.
The Annals of Thoracic Surgery
|April 1, 2021
Summary
Technical modifications to the Ross procedure (RP) may improve pulmonary valve autograft (PVA) durability in children. These surgical refinements enhance long-term function and growth of the PVA, offering a promising solution for pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Aortic Valve Repair
- Autograft Preservation
Background:
- Pulmonary valve autograft (PVA) failure after the Ross procedure (RP) limits its widespread use.
- Modifications and alternatives to the RP are being explored to improve outcomes, especially in pediatric patients.
Purpose of the Study:
- To analyze the impact of specific technical modifications on the results of the Ross procedure in children.
- To assess the long-term durability and growth of the pulmonary valve autograft following these modifications.
Main Methods:
- Retrospective analysis of 69 pediatric patients undergoing the RP (median age, 12 years) between 1996 and 2018.
- Concomitant Konno procedure in 29% of patients; prior valvuloplasty in a significant proportion.
- Technical modifications included native root annuloplasty, uniplanar horizontal sutures, sinotubular junction normalization, and root remnant wrapping.
Main Results:
- Low operative mortality (1.5%) and no late deaths.
- No neoaortic stenosis; mild regurgitation in 10% at discharge.
- Excellent long-term freedom from autograft replacement (87% at 20 years) and reintervention.
Conclusions:
- Technical modifications to the Ross procedure can potentially enhance the longevity of the pulmonary valve autograft in pediatric patients.
- These modifications appear to preserve autograft growth without compromising function, a critical factor for pediatric recipients.
