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Extending the limits of the Ross procedure
V M Reddy1, H A Rajasinghe, D B McElhinney
1Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA.
Insights
The autologous pulmonary valve serves as an excellent aortic valve replacement option for all ages. This technique is particularly effective for neonates, infants, and patients with complex left ventricular outflow tract obstruction.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- The native pulmonary valve's growth potential and durability make it suitable for aortic valve replacement.
- Its application can be extended to pediatric patients with complex left ventricular outflow tract obstruction, including neonates and infants.
Purpose of the Study:
- To evaluate the efficacy and safety of using the autologous pulmonary valve for aortic valve replacement in a diverse patient population.
- To assess the feasibility of this procedure in complex cases, including neonates, infants, and those with left ventricular outflow tract obstruction.
Main Methods:
- The Ross procedure was performed on 35 patients between June 1993 and May 1995.
- 15 patients had complex left ventricular outflow tract obstruction, and 7 were infants (3 neonates).
- Procedures included root replacement with coronary reimplantation, ventricular myectomy, and Konno type aortoventriculoplasty.
Main Results:
- One early death occurred in a patient with borderline hypoplastic left heart syndrome.
- No late deaths or reinterventions were observed at a median follow-up of 9 months.
- Autologous pulmonary valve function was excellent, with only one patient experiencing moderate insufficiency.
Conclusions:
- Autologous pulmonary valve replacement is a highly effective option for aortic valve disease across all age groups.
- The procedure is well-suited for neonates, infants, and patients requiring concurrent left ventricular outflow tract procedures.
Background:
The potential for growth and the proven long-term durability of the native pulmonary valve make it ideal for replacement of the diseased aortic valve, especially in growing children. The use of the autologous pulmonary valve can be further extended to patients with complex left ventricular outflow tract obstruction and to neonates and infants.
Methods:
Between June 1993 and May 1995, 35 patients underwent the Ross procedure at our center. Of these, 15 (43%) had complex left ventricular outflow tract obstruction and 7 (20%) were infants, including 3 neonates. The autologous pulmonary valve was implanted as a root replacement with coronary reimplantation in all patients. Additional left ventricular outflow tract procedures performed were ventricular myectomy in 7 patients and a Konno type aortoventriculoplasty in 11 patients.
Results:
There was one early death in a patient with borderline hypoplastic left heart syndrome. At a median follow-up of 9 months (range, 0.2 to 22 months) there were no late deaths or reinterventions. The autologous pulmonary valve function was excellent, with 1 (2.8%) patient having moderate insufficiency.
Conclusions:
Autologous pulmonary valve is an excellent option for aortic valve replacement in all age groups. Its use can be readily extended to neonates, infants, and patients with complex left ventricular obstruction requiring additional left ventricular outflow tract procedures.