Modification of the Ross aortic valve replacement to prevent late autograft dilatation

John W. Brown, Mark Ruzmetov, Ali P. Shahriari, Mark D. Rodefeld, Yousuf Mahomed, Mark W. Turrentine

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: Aortic root dilatation with and without aortic regurgitation is seen in up to 20% of patients undergoing a Ross aortic root replacement at late follow-up. We present our early experience with reduction annuloplasty combined with prosthetic Dacron graft replacement of the aorta above the autograft to prevent late dilation after a Ross aortic root replacement. Methods: Since 2001, 31 of 97 adult and paediatric patients (mean age 28.8 ± 14.4 years; range 8-53 years) with bicuspid aortic valve and dilatation of the ascending aorta underwent a modified Ross procedure with reduction annuloplasty combined with prosthetic Dacron graft replacement of the ascending aorta. The diameter of the ascending aorta was measured before and early after surgery and then between 3 months and 8 years' follow-up (mean, 2.5 ± 2.2 years). Results: There were no early or late deaths. Reduction annuloplasty combined with ascending aortic graft replacement decreased the diameters of the ascending aorta from 42 ± 7.0 mm preoperatively to 25 ± 2.9 mm early after surgery (p < 0.001). During follow-up, there was no significant increase of the aortic diameter compared with that during the postoperative period (27 ± 4.3 mm; p = 0.07). The root diameter increased in only 3 of 31 patients (10%). No patient underwent re-operation. At last follow-up, mild (n = 18) or trivial (n = 13) aortic regurgitation was observed. Conclusion: Ross aortic root replacement combined with reduction annuloplasty and Dacron graft replacement of the ascending aorta demonstrated excellent early- to mid-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Continued use and long-term follow-up imaging is necessary to further demonstrate the value of this technical modification.

Original languageEnglish (US)
Pages (from-to)1002-1007
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume37
Issue number5
DOIs
StatePublished - May 1 2010

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Autografts
Aortic Valve
Aorta
Dilatation
Polyethylene Terephthalates
Transplants
Aortic Valve Insufficiency
Postoperative Period
Pediatrics

Keywords

  • Aortic valve replacement
  • Dilatation
  • Pulmonary autograft
  • Ross procedure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Modification of the Ross aortic valve replacement to prevent late autograft dilatation. / Brown, John W.; Ruzmetov, Mark; Shahriari, Ali P.; Rodefeld, Mark D.; Mahomed, Yousuf; Turrentine, Mark W.

In: European Journal of Cardio-thoracic Surgery, Vol. 37, No. 5, 01.05.2010, p. 1002-1007.

Research output: Contribution to journalArticle

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abstract = "Objective: Aortic root dilatation with and without aortic regurgitation is seen in up to 20{\%} of patients undergoing a Ross aortic root replacement at late follow-up. We present our early experience with reduction annuloplasty combined with prosthetic Dacron graft replacement of the aorta above the autograft to prevent late dilation after a Ross aortic root replacement. Methods: Since 2001, 31 of 97 adult and paediatric patients (mean age 28.8 ± 14.4 years; range 8-53 years) with bicuspid aortic valve and dilatation of the ascending aorta underwent a modified Ross procedure with reduction annuloplasty combined with prosthetic Dacron graft replacement of the ascending aorta. The diameter of the ascending aorta was measured before and early after surgery and then between 3 months and 8 years' follow-up (mean, 2.5 ± 2.2 years). Results: There were no early or late deaths. Reduction annuloplasty combined with ascending aortic graft replacement decreased the diameters of the ascending aorta from 42 ± 7.0 mm preoperatively to 25 ± 2.9 mm early after surgery (p < 0.001). During follow-up, there was no significant increase of the aortic diameter compared with that during the postoperative period (27 ± 4.3 mm; p = 0.07). The root diameter increased in only 3 of 31 patients (10{\%}). No patient underwent re-operation. At last follow-up, mild (n = 18) or trivial (n = 13) aortic regurgitation was observed. Conclusion: Ross aortic root replacement combined with reduction annuloplasty and Dacron graft replacement of the ascending aorta demonstrated excellent early- to mid-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Continued use and long-term follow-up imaging is necessary to further demonstrate the value of this technical modification.",
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AU - Ruzmetov, Mark

AU - Shahriari, Ali P.

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N2 - Objective: Aortic root dilatation with and without aortic regurgitation is seen in up to 20% of patients undergoing a Ross aortic root replacement at late follow-up. We present our early experience with reduction annuloplasty combined with prosthetic Dacron graft replacement of the aorta above the autograft to prevent late dilation after a Ross aortic root replacement. Methods: Since 2001, 31 of 97 adult and paediatric patients (mean age 28.8 ± 14.4 years; range 8-53 years) with bicuspid aortic valve and dilatation of the ascending aorta underwent a modified Ross procedure with reduction annuloplasty combined with prosthetic Dacron graft replacement of the ascending aorta. The diameter of the ascending aorta was measured before and early after surgery and then between 3 months and 8 years' follow-up (mean, 2.5 ± 2.2 years). Results: There were no early or late deaths. Reduction annuloplasty combined with ascending aortic graft replacement decreased the diameters of the ascending aorta from 42 ± 7.0 mm preoperatively to 25 ± 2.9 mm early after surgery (p < 0.001). During follow-up, there was no significant increase of the aortic diameter compared with that during the postoperative period (27 ± 4.3 mm; p = 0.07). The root diameter increased in only 3 of 31 patients (10%). No patient underwent re-operation. At last follow-up, mild (n = 18) or trivial (n = 13) aortic regurgitation was observed. Conclusion: Ross aortic root replacement combined with reduction annuloplasty and Dacron graft replacement of the ascending aorta demonstrated excellent early- to mid-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Continued use and long-term follow-up imaging is necessary to further demonstrate the value of this technical modification.

AB - Objective: Aortic root dilatation with and without aortic regurgitation is seen in up to 20% of patients undergoing a Ross aortic root replacement at late follow-up. We present our early experience with reduction annuloplasty combined with prosthetic Dacron graft replacement of the aorta above the autograft to prevent late dilation after a Ross aortic root replacement. Methods: Since 2001, 31 of 97 adult and paediatric patients (mean age 28.8 ± 14.4 years; range 8-53 years) with bicuspid aortic valve and dilatation of the ascending aorta underwent a modified Ross procedure with reduction annuloplasty combined with prosthetic Dacron graft replacement of the ascending aorta. The diameter of the ascending aorta was measured before and early after surgery and then between 3 months and 8 years' follow-up (mean, 2.5 ± 2.2 years). Results: There were no early or late deaths. Reduction annuloplasty combined with ascending aortic graft replacement decreased the diameters of the ascending aorta from 42 ± 7.0 mm preoperatively to 25 ± 2.9 mm early after surgery (p < 0.001). During follow-up, there was no significant increase of the aortic diameter compared with that during the postoperative period (27 ± 4.3 mm; p = 0.07). The root diameter increased in only 3 of 31 patients (10%). No patient underwent re-operation. At last follow-up, mild (n = 18) or trivial (n = 13) aortic regurgitation was observed. Conclusion: Ross aortic root replacement combined with reduction annuloplasty and Dacron graft replacement of the ascending aorta demonstrated excellent early- to mid-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Continued use and long-term follow-up imaging is necessary to further demonstrate the value of this technical modification.

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KW - Dilatation

KW - Pulmonary autograft

KW - Ross procedure

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