The Ross full root replacement in adults with bicuspid aortic valve disease

John Brown, Mark Ruzmetov, Ali Shahriari, Mark Rodefeld, Mark Turrentine, Yousuf Mahomed

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and aim of the study: Bicuspid aortic valve disease (BAVD) is the most common congenital cardiac lesion causing aortic stenosis in adults. This lesion can be associated with a histological abnormality of the aortic wall and dilated or aneurysmal ascending aorta. In younger patients, the Ross operation offers several advantages over conventional aortic valve replacement (AVR); however, the rationale of performing this procedure on adults in the face of BAVD have been questioned. Methods: Between 1994 and 2009, a total of 101 adult patients (mean age 36 years; range: 18-61 years) with BAVD underwent the Ross full root replacement at the authors' institution. Of these patients, 23 (23%) had an aneurysmal ascending aorta (4.0-5.2 cm) associated with BAVD which was resected at the time of, or subsequent to, a Ross AVR. The end point of the study was freedom from Ross autograft dilatation >4.0 cm, dysfunction, or valve repair or replacement. Results: The mean follow up was 6.0 ± 3.9 years. At the latest follow up, 19 patients (19%) had a dilated ascending aorta with a mean size 45.1 mm (range: 40-64 mm). Eight patients (8%) required a redo operation on the autograft. Three of seven patients undergoing reoperation had their autograft valve preserved; the remaining four underwent a modified Bentall root replacement. One patient had a repair of a left ventricular pseudoaneurysm below the Ross valve. Only three patients with preoperative ascending aorta dilation developed late autograft dilation. Freedom from autograft dilatation >4.0 cm, dysfunction, repair or replacement was 80% at 10 years. Conclusion: Mid-term results indicate that Ross AVR in adults with BAVD had good outcomes, with a low incidence of autograft-related complications. In almost half of the patients undergoing reoperation, the autograft valve was preserved. The incidence of autograft valve insufficiency and dilatation might be further reduced by: (i) aggressively treating any postoperative systemic hypertension; (ii) externally fortifying the annulus and sinotubular junction of the autograft with Dacron strips; and/or (iii) replacing a dilated ascending aorta with a Dacron interposition graft. The preoperative diagnosis of BAVD and/or aneurysmal ascending aorta is not predictive of late autograft dilatation or failure.

Original languageEnglish
Pages (from-to)332-339
Number of pages8
JournalJournal of Heart Valve Disease
Volume20
Issue number3
StatePublished - May 2011

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Aortic Diseases
Autografts
Aorta
Dilatation
Aortic Valve
Polyethylene Terephthalates
Reoperation
Bicuspid Aortic Valve
False Aneurysm
Aortic Valve Stenosis
Incidence
Hypertension
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The Ross full root replacement in adults with bicuspid aortic valve disease. / Brown, John; Ruzmetov, Mark; Shahriari, Ali; Rodefeld, Mark; Turrentine, Mark; Mahomed, Yousuf.

In: Journal of Heart Valve Disease, Vol. 20, No. 3, 05.2011, p. 332-339.

Research output: Contribution to journalArticle

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abstract = "Background and aim of the study: Bicuspid aortic valve disease (BAVD) is the most common congenital cardiac lesion causing aortic stenosis in adults. This lesion can be associated with a histological abnormality of the aortic wall and dilated or aneurysmal ascending aorta. In younger patients, the Ross operation offers several advantages over conventional aortic valve replacement (AVR); however, the rationale of performing this procedure on adults in the face of BAVD have been questioned. Methods: Between 1994 and 2009, a total of 101 adult patients (mean age 36 years; range: 18-61 years) with BAVD underwent the Ross full root replacement at the authors' institution. Of these patients, 23 (23{\%}) had an aneurysmal ascending aorta (4.0-5.2 cm) associated with BAVD which was resected at the time of, or subsequent to, a Ross AVR. The end point of the study was freedom from Ross autograft dilatation >4.0 cm, dysfunction, or valve repair or replacement. Results: The mean follow up was 6.0 ± 3.9 years. At the latest follow up, 19 patients (19{\%}) had a dilated ascending aorta with a mean size 45.1 mm (range: 40-64 mm). Eight patients (8{\%}) required a redo operation on the autograft. Three of seven patients undergoing reoperation had their autograft valve preserved; the remaining four underwent a modified Bentall root replacement. One patient had a repair of a left ventricular pseudoaneurysm below the Ross valve. Only three patients with preoperative ascending aorta dilation developed late autograft dilation. Freedom from autograft dilatation >4.0 cm, dysfunction, repair or replacement was 80{\%} at 10 years. Conclusion: Mid-term results indicate that Ross AVR in adults with BAVD had good outcomes, with a low incidence of autograft-related complications. In almost half of the patients undergoing reoperation, the autograft valve was preserved. The incidence of autograft valve insufficiency and dilatation might be further reduced by: (i) aggressively treating any postoperative systemic hypertension; (ii) externally fortifying the annulus and sinotubular junction of the autograft with Dacron strips; and/or (iii) replacing a dilated ascending aorta with a Dacron interposition graft. The preoperative diagnosis of BAVD and/or aneurysmal ascending aorta is not predictive of late autograft dilatation or failure.",
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AU - Ruzmetov, Mark

AU - Shahriari, Ali

AU - Rodefeld, Mark

AU - Turrentine, Mark

AU - Mahomed, Yousuf

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