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Autograft Reoperation Following the Ross Procedure: Evolving Strategies and Future Perspectives.
Generali, Tommaso; McPherson, Iain; Visan, Alexandru C; Mohamed, Amir; Salem, Mahmoud I; Jansen, Katrijn; Coats, Louise; Rybicka, Justyna; Crossland, David; Hasan, Asif; Nassar, Mohamed.
Afiliación
  • Generali T; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
  • McPherson I; Congenital Heart Disease Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
  • Visan AC; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
  • Mohamed A; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
  • Salem MI; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
  • Jansen K; Cardiothoracic Surgery Department, Alexandria University, Alexandria, Egypt.
  • Coats L; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
  • Rybicka J; Cardiothoracic Surgery Department, Port Said University, Port Said, Egypt.
  • Crossland D; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
  • Hasan A; Congenital Heart Disease Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
  • Nassar M; Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle-upon-Tyne, UK.
World J Pediatr Congenit Heart Surg ; 15(5): 571-580, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38715391
ABSTRACT

Background:

Pulmonary autograft failure remains a cause of reoperation following the Ross procedure. The aim of this study is to describe our evolving approach to autograft reoperations.

Methods:

Retrospective study of all patients who underwent a pulmonary autograft reoperation following a Ross procedure between June 1997 and July 2022.

Results:

Two-hundred and thirty-five Ross procedures were performed. Thirty-six patients (15%) plus one referral underwent an autograft reoperation at a median of 7.8 years (IQR 4.6-13.6). The main indication was neoaortic root dilatation associated with mild/moderate (n = 12) or severe (n = 8) aortic regurgitation; isolated severe aortic regurgitation (n = 6); infective endocarditis (IE) (n = 8); and aortic root pseudoaneurysm with no history of IE (n = 3). The autograft was spared in 29 cases (78%) 9 patients (24%) underwent aortic valve repair or aortic root remodeling, 15 patients (40%) aortic root reimplantation, 5 patients neoaortic root stabilization with a Personalized External Aortic Root Support (PEARS) sleeve. There were no in-hospital deaths. At a median follow up of 37 months (IQR 8-105), all patients were alive, 30 (81%) were asymptomatic. Eight patients (22%) required nine further reoperations. Estimated freedom from further reoperation was 90%, 72%, and 72% at 12-, 36-, and 60-months.

Conclusions:

Autograft reoperations following the Ross procedure can be safely performed and do not affect overall survival in the early and mid-term. Valve-sparing autograft replacement is technically feasible but remains at risk of further interventions. Alternative strategies, such as the PEARS sleeve, are becoming increasingly available but requires validation in the long term.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Válvula Pulmonar / Reoperación / Autoinjertos Límite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: World J Pediatr Congenit Heart Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Válvula Pulmonar / Reoperación / Autoinjertos Límite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: World J Pediatr Congenit Heart Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos