Current techniques to reduce blood loss after the Ross procedure

Area of Science:

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

Background:

• Pulmonary autograft (PA) offers theoretical benefits for aortic valve replacement but presents surgical complexity and bleeding risks.
• Early experience with PA demonstrated a high incidence of re-exploration for bleeding and significant blood loss.

Purpose of the Study:

• To evaluate the impact of modified pharmacological and surgical strategies on blood loss and transfusion requirements following PA use.
• To assess the feasibility of blood loss containment in PA aortic valve replacement.

Main Methods:

• A cohort of 26 patients underwent aortic valve replacement with PA (July 1994-March 1997).
• Patients were divided into an early experience group (Group I, n=8) and a later group (Group II, n=18) after implementing new strategies.
• Strategies included perioperative aprotinin, autologous pericardium for suture line reinforcement, and precise hemostasis with fibrin glue during circulatory arrest.

Main Results:

• No hospital deaths occurred in either group.
• Group II patients showed significantly reduced mean total postoperative blood loss (323 ml/m2 BSA) compared to Group I (720 ml/m2 BSA).
• No patients in Group II required re-exploration for bleeding or blood transfusion; bypass and cross-clamp times were not prolonged.

Conclusions:

• Early survival after PA aortic valve replacement is comparable to conventional substitutes.
• Routine application of medical and surgical strategies effectively contains blood loss.
• These findings support wider indications for the Ross procedure, particularly given concerns about blood transfusions in young patients.