Mitral valve replacement with Ross II technique

Initial experience

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background. Pulmonary autograft mitral valve replacement (PA-MVR) was introduced clinically by Ross in 1967, but has been rarely utilized in North America and Europe. The aim of this study is to review our early experience with PA-MVR. Methods. Since June 2002, 8 patients (7 female and 1 male) between 12 to 46 years of age with outgrown mechanical valves (n = 3) failed MV repair for rheumatic or congenital MV disease (n = 4) and irreparable bileaflet myxoid prolapse (n = 1), underwent PA-MVR. The pulmonary autograft was harvested and replaced using a pulmonary homograft. The autografts were mounted within a woven Dacron graft 6-8 mm greater in diameter than the autograft annulus diameter on a preoperative echocardiogram. The graft's external surface was covered with fresh autologous pericardium. Results. There were no deaths. Intraoperative echocardiography confirmed a mean MV gradient of 4 mm Hg with trivial (n = 7) or mild (n = 1) regurgitation. Follow-up (range, 13 to 36 months) echocardiography in 4 patients showed no increase in MV gradient or regurgitation. One patient with severe myxoid degeneration and one patient with rheumatic disease, both with systemic hypertension, developed progressive regurgitation due to stretching of a single autograft leaflet producing prolapse. One patient developed a moderate gradient due to retention of excessive native mitral leaflet and subannular chordal tissue. Three of 4 patients have required PA-MVR replacement with mechanical valves 6 to 14 months post-PA-MVR. One asymptomatic patient with mild to moderate mitral regurgitation is being followed after treatment of her systemic hypertension. Conclusions. Pulmonary autograft mitral valve replacement offers selected patients a potentially lifelong autologous valve without the need for long-term anticoagulation. The PA-MVR technique deserves careful consideration in younger patients in sinus rhythm. Postoperative systemic hypertension should be treated aggressively to prevent excessive stress on the pulmonary autograft particularly in the early postoperative months.

Original languageEnglish
Pages (from-to)502-508
Number of pages7
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 2006

Fingerprint

Autografts
Mitral Valve
Lung
Prolapse
Hypertension
Echocardiography
Transplants
Polyethylene Terephthalates
Pericardium
Mitral Valve Insufficiency
North America
Rheumatic Diseases
Allografts

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Mitral valve replacement with Ross II technique : Initial experience. / Brown, John; Ruzmetov, Mark; Rodefeld, Mark; Turrentine, Mark.

In: Annals of Thoracic Surgery, Vol. 81, No. 2, 02.2006, p. 502-508.

Research output: Contribution to journalArticle

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abstract = "Background. Pulmonary autograft mitral valve replacement (PA-MVR) was introduced clinically by Ross in 1967, but has been rarely utilized in North America and Europe. The aim of this study is to review our early experience with PA-MVR. Methods. Since June 2002, 8 patients (7 female and 1 male) between 12 to 46 years of age with outgrown mechanical valves (n = 3) failed MV repair for rheumatic or congenital MV disease (n = 4) and irreparable bileaflet myxoid prolapse (n = 1), underwent PA-MVR. The pulmonary autograft was harvested and replaced using a pulmonary homograft. The autografts were mounted within a woven Dacron graft 6-8 mm greater in diameter than the autograft annulus diameter on a preoperative echocardiogram. The graft's external surface was covered with fresh autologous pericardium. Results. There were no deaths. Intraoperative echocardiography confirmed a mean MV gradient of 4 mm Hg with trivial (n = 7) or mild (n = 1) regurgitation. Follow-up (range, 13 to 36 months) echocardiography in 4 patients showed no increase in MV gradient or regurgitation. One patient with severe myxoid degeneration and one patient with rheumatic disease, both with systemic hypertension, developed progressive regurgitation due to stretching of a single autograft leaflet producing prolapse. One patient developed a moderate gradient due to retention of excessive native mitral leaflet and subannular chordal tissue. Three of 4 patients have required PA-MVR replacement with mechanical valves 6 to 14 months post-PA-MVR. One asymptomatic patient with mild to moderate mitral regurgitation is being followed after treatment of her systemic hypertension. Conclusions. Pulmonary autograft mitral valve replacement offers selected patients a potentially lifelong autologous valve without the need for long-term anticoagulation. The PA-MVR technique deserves careful consideration in younger patients in sinus rhythm. Postoperative systemic hypertension should be treated aggressively to prevent excessive stress on the pulmonary autograft particularly in the early postoperative months.",
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