Fate of the autograft and homograft following ross aortic valve replacement: Reoperative frequency, outcome, and management

John W. Brown, Mark Ruzmetov, Toshihiro Fukui, Mark D. Rodefeld, Yousuf Mahomed, Mark W. Turrentine

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background and aim of the study: The optimal hemodynamic performance and potential for growth of the pulmonary autograft has led to expanded indications for the Ross aortic valve replacement (AVR) procedure in some centers. The authors' institutional midterm experience was reviewed to assess autograft and homograft hemodynamics, growth profile of the autograft, and reoperative frequency following Ross AVR. Methods: Between June 1993 and June 2005, 167 consecutive patients (mean age 24.9 ± 15.5 years; range: 1 month to 61 years) underwent Ross AVR: 48% of patients were aged <19 years. Additional procedures (n = 78) were performed in 55 patients (33%) at the time of the Ross procedure. In total, 151 patients had isolated aortic valve disease and 16 pediatric patients had more complex, multi-level left ventricular outflow tract obstruction. Results: There were two early deaths (1.2%) and one late death (0.6%) over a mean follow up of 5.1 ± 3.0 years (range: 1 month to 11 years). Actuarial survival at 10 years was 98%. In pediatric patients with Konno procedure (n = 16), the pulmonary autograft mean annulus diameter increased from 10.2 to 19.9 mm. Twelve patients underwent 12 reoperations without mortality for autograft insufficiency or an ascending aortic aneurysm at a median interval of 5 years (range: 2 to 8 years): aortic annuloplasty and ascending aorta replacement (n = 4), composite aortic root replacement (n = 7), and repair of left ventricular pseudoaneurysm (n = 1). Freedom from replacement of the pulmonary autograft was 96% at 10 years. Five of the 164 surviving patients (3%) developed significant obstruction of the pulmonary homograft and required conduit replacement at a median of four years. Conclusion: The Ross AVR can be performed with good mid-term results, including the pediatric age group. The potential for development of significant autograft insufficiency and homograft stenosis warrants annual follow up through the intermediate and late terms.

Original languageEnglish (US)
Pages (from-to)253-260
Number of pages8
JournalJournal of Heart Valve Disease
Volume15
Issue number2
StatePublished - Mar 1 2006

Fingerprint

Autografts
Aortic Valve
Allografts
Lung
Pediatrics
Hemodynamics
Ventricular Outflow Obstruction
Aortic Diseases
Aortic Aneurysm
False Aneurysm
Growth
Reoperation
Aorta
Pathologic Constriction
Age Groups
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Fate of the autograft and homograft following ross aortic valve replacement : Reoperative frequency, outcome, and management. / Brown, John W.; Ruzmetov, Mark; Fukui, Toshihiro; Rodefeld, Mark D.; Mahomed, Yousuf; Turrentine, Mark W.

In: Journal of Heart Valve Disease, Vol. 15, No. 2, 01.03.2006, p. 253-260.

Research output: Contribution to journalArticle

@article{a5bbcdb5d182491eb9bb6163c337afa0,
title = "Fate of the autograft and homograft following ross aortic valve replacement: Reoperative frequency, outcome, and management",
abstract = "Background and aim of the study: The optimal hemodynamic performance and potential for growth of the pulmonary autograft has led to expanded indications for the Ross aortic valve replacement (AVR) procedure in some centers. The authors' institutional midterm experience was reviewed to assess autograft and homograft hemodynamics, growth profile of the autograft, and reoperative frequency following Ross AVR. Methods: Between June 1993 and June 2005, 167 consecutive patients (mean age 24.9 ± 15.5 years; range: 1 month to 61 years) underwent Ross AVR: 48{\%} of patients were aged <19 years. Additional procedures (n = 78) were performed in 55 patients (33{\%}) at the time of the Ross procedure. In total, 151 patients had isolated aortic valve disease and 16 pediatric patients had more complex, multi-level left ventricular outflow tract obstruction. Results: There were two early deaths (1.2{\%}) and one late death (0.6{\%}) over a mean follow up of 5.1 ± 3.0 years (range: 1 month to 11 years). Actuarial survival at 10 years was 98{\%}. In pediatric patients with Konno procedure (n = 16), the pulmonary autograft mean annulus diameter increased from 10.2 to 19.9 mm. Twelve patients underwent 12 reoperations without mortality for autograft insufficiency or an ascending aortic aneurysm at a median interval of 5 years (range: 2 to 8 years): aortic annuloplasty and ascending aorta replacement (n = 4), composite aortic root replacement (n = 7), and repair of left ventricular pseudoaneurysm (n = 1). Freedom from replacement of the pulmonary autograft was 96{\%} at 10 years. Five of the 164 surviving patients (3{\%}) developed significant obstruction of the pulmonary homograft and required conduit replacement at a median of four years. Conclusion: The Ross AVR can be performed with good mid-term results, including the pediatric age group. The potential for development of significant autograft insufficiency and homograft stenosis warrants annual follow up through the intermediate and late terms.",
author = "Brown, {John W.} and Mark Ruzmetov and Toshihiro Fukui and Rodefeld, {Mark D.} and Yousuf Mahomed and Turrentine, {Mark W.}",
year = "2006",
month = "3",
day = "1",
language = "English (US)",
volume = "15",
pages = "253--260",
journal = "Journal of Heart Valve Disease",
issn = "0966-8519",
publisher = "ICR Publishers Ltd",
number = "2",

}

TY - JOUR

T1 - Fate of the autograft and homograft following ross aortic valve replacement

T2 - Reoperative frequency, outcome, and management

AU - Brown, John W.

AU - Ruzmetov, Mark

AU - Fukui, Toshihiro

AU - Rodefeld, Mark D.

AU - Mahomed, Yousuf

AU - Turrentine, Mark W.

PY - 2006/3/1

Y1 - 2006/3/1

N2 - Background and aim of the study: The optimal hemodynamic performance and potential for growth of the pulmonary autograft has led to expanded indications for the Ross aortic valve replacement (AVR) procedure in some centers. The authors' institutional midterm experience was reviewed to assess autograft and homograft hemodynamics, growth profile of the autograft, and reoperative frequency following Ross AVR. Methods: Between June 1993 and June 2005, 167 consecutive patients (mean age 24.9 ± 15.5 years; range: 1 month to 61 years) underwent Ross AVR: 48% of patients were aged <19 years. Additional procedures (n = 78) were performed in 55 patients (33%) at the time of the Ross procedure. In total, 151 patients had isolated aortic valve disease and 16 pediatric patients had more complex, multi-level left ventricular outflow tract obstruction. Results: There were two early deaths (1.2%) and one late death (0.6%) over a mean follow up of 5.1 ± 3.0 years (range: 1 month to 11 years). Actuarial survival at 10 years was 98%. In pediatric patients with Konno procedure (n = 16), the pulmonary autograft mean annulus diameter increased from 10.2 to 19.9 mm. Twelve patients underwent 12 reoperations without mortality for autograft insufficiency or an ascending aortic aneurysm at a median interval of 5 years (range: 2 to 8 years): aortic annuloplasty and ascending aorta replacement (n = 4), composite aortic root replacement (n = 7), and repair of left ventricular pseudoaneurysm (n = 1). Freedom from replacement of the pulmonary autograft was 96% at 10 years. Five of the 164 surviving patients (3%) developed significant obstruction of the pulmonary homograft and required conduit replacement at a median of four years. Conclusion: The Ross AVR can be performed with good mid-term results, including the pediatric age group. The potential for development of significant autograft insufficiency and homograft stenosis warrants annual follow up through the intermediate and late terms.

AB - Background and aim of the study: The optimal hemodynamic performance and potential for growth of the pulmonary autograft has led to expanded indications for the Ross aortic valve replacement (AVR) procedure in some centers. The authors' institutional midterm experience was reviewed to assess autograft and homograft hemodynamics, growth profile of the autograft, and reoperative frequency following Ross AVR. Methods: Between June 1993 and June 2005, 167 consecutive patients (mean age 24.9 ± 15.5 years; range: 1 month to 61 years) underwent Ross AVR: 48% of patients were aged <19 years. Additional procedures (n = 78) were performed in 55 patients (33%) at the time of the Ross procedure. In total, 151 patients had isolated aortic valve disease and 16 pediatric patients had more complex, multi-level left ventricular outflow tract obstruction. Results: There were two early deaths (1.2%) and one late death (0.6%) over a mean follow up of 5.1 ± 3.0 years (range: 1 month to 11 years). Actuarial survival at 10 years was 98%. In pediatric patients with Konno procedure (n = 16), the pulmonary autograft mean annulus diameter increased from 10.2 to 19.9 mm. Twelve patients underwent 12 reoperations without mortality for autograft insufficiency or an ascending aortic aneurysm at a median interval of 5 years (range: 2 to 8 years): aortic annuloplasty and ascending aorta replacement (n = 4), composite aortic root replacement (n = 7), and repair of left ventricular pseudoaneurysm (n = 1). Freedom from replacement of the pulmonary autograft was 96% at 10 years. Five of the 164 surviving patients (3%) developed significant obstruction of the pulmonary homograft and required conduit replacement at a median of four years. Conclusion: The Ross AVR can be performed with good mid-term results, including the pediatric age group. The potential for development of significant autograft insufficiency and homograft stenosis warrants annual follow up through the intermediate and late terms.

UR - http://www.scopus.com/inward/record.url?scp=33645640437&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645640437&partnerID=8YFLogxK

M3 - Article

C2 - 16607909

AN - SCOPUS:33645640437

VL - 15

SP - 253

EP - 260

JO - Journal of Heart Valve Disease

JF - Journal of Heart Valve Disease

SN - 0966-8519

IS - 2

ER -