RESUMEN
The Ross procedure has shown superior hemodynamic results in young patients with aortic root pathology. Wider application of the procedure is restricted by its technical complexity and potential associated problems. The mortality/morbidity associated with 130 consecutive patients who have had the Ross procedure using the root replacement implantation technique between October 29, 1990, and October 8, 1998 is summarized. New York Heart Association (NYHA) preoperatively was class I, 23.5%; class II, 64.7%; and class III, 11.8%; mean age was 36 years (range 3 to 67 years). Men accounted for 73.8% and women 26.2% of the series. Preoperative diagnosis was congenital, 80.7%; rheumatic, 5.3%; failed prosthesis, 7.0%; degenerative, 2.6%; and endocarditis, 4.4% with preoperative aortic insufficiency (AI) 7.9% 1+, 19.8% 2+, 29.7% 3+, and 42.6% 4+, respectively. At operation mean cross-clamp time was 201 minutes (range 102 to 280 minutes). Patient follow-up was 99.2% (1 patient lost to follow-up), and 94.4% were NYHA class I at follow-up and 5.6% class II. Postoperative AI was 0 to 1 + in 93.6% and 2+ or greater in 6.4%. Mean time to patient follow-up was 436 days (range, 20 days to 2,878 days). Thirty-day mortality rate was 1.5%; one patient died of mediastinal bleeding, and one from complications of acute pancreatitis. There was no late mortality. Early autograft explant occurred in one patient secondary to iatrogenic injury to the pulmonary autograft at the time of harvesting, and one late explant occurred secondary to proximal suture line dehiscence. Late autograft repair occurred in one patient secondary to a false aneurysm along the proximal suture line; one patient was reoperated for left main coronary stenosis relative to iatrogenic injury at the time of the procedure. Right ventricular outflow tract replacement has occurred in two patients. Postoperative morbidity and mortality for the Ross procedure, as shown in this series, remains low and supports broader application of the procedure.
Asunto(s)
Válvula Aórtica/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Válvula Pulmonar/trasplante , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Aortic prosthetic devices offer limitations that make them less than optimal valve substitutes because the vast majority are innately obstructive, especially at increased levels of hemodynamic function. The present study is designed to demonstrate the hemodynamics of the pulmonary autograft in 11 conditioned athletes who have undergone the Ross (pulmonary autograft) procedure. Data was compared to a group of 13 age-matched "normal athletes." METHODS: All the Ross athletes had undergone the autograft procedure using the root replacement technique and were at least 3 months into their postrecovery phase. All athletes (both normal and Ross) underwent resting transthoracic echo followed by maximal exercise stress test (modified Bruce protocol) to exhaustion. Post-operative transesphogeal echocardiogram obtained within 90 seconds documented aortic valve gradient and velocity across the aortic valve. RESULTS: In the Ross athlete group, maximum heart rate was 188 beats per minute, peak aortic valve gradient at rest (mm Hg) 7.69 (mean), velocity across the aortic valve at rest (cm per second) 129.40 (mean), peak aortic valve gradient at maximal exercise (mm Hg) 16.30 (mean), velocity across the aortic valve at maximal exercise (cm per second) 190.00 (mean). In the normal athlete group, maximum heart rate was 176 beats/minute, peak aortic valve gradient at rest (mm Hg) 5.97 (mean), velocity across the aortic valve at rest (cm per second) 120.54 (mean), peak aortic valve gradient at maximal exercise (mm Hg) 14.61 (mean), velocity across the aortic valve at maximal exercise (cm per second) 190.23 (mean). CONCLUSION: The pulmonary autograft exhibits hemodynamic characteristics similar to the normal human aortic valve under conditions of enhanced cardiac output.