Do surgical modifications at the annular level during the Ross procedure negatively influence the structural and functional durability of the autograft?
- Lögers A University of Zurich, Zurich, Switzerland.
- Rosser B Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
- Seifert B Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
- Kretschmar O Department of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.
- Hübler M Department of Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland.
- Prêtre R Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland.
- Ben Mime L Department of Surgery for Congenital Heart Defects, Pediatric Heart Center Duisburg, University of Düsseldorf, Duisburg, Germany.
- 2018-05-18
Published in:
- Interactive cardiovascular and thoracic surgery. - 2018
Adolescent
Aortic Valve
Autografts
Cardiac Surgical Procedures
Child
Child, Preschool
Echocardiography
Electrocardiography, Ambulatory
Female
Heart Valve Diseases
Humans
Infant
Infant, Newborn
Male
Reoperation
Retrospective Studies
Ventricular Outflow Obstruction
English
OBJECTIVES
Do surgical modifications at the annular level (e.g. the modified Ross-Konno procedure or reduction plasty) influence the structure and function of the Ross autograft at the mid-term follow-up?
METHODS
From June 2001 to July 2009, 49 patients (37 men and 12 women), mean age 10.5 ± 5.7 years (range 2 weeks to 17.8 years), underwent Ross operations. Twenty-one patients underwent additional aortic annulus reduction plasty and 9 patients a modified Ross-Konno procedure. The need for reintervention, reoperation and valve function were retrospectively analysed for a mean follow-up of 4.6 ± 2.7 years (range 9 days to 9.2 years).
RESULTS
There were no intraoperative or early death. Three late deaths occurred. Survival at 4 years was 91.9 ± 4.6%. In the overall cohort, aortic annular growth was 1 mm/year, corresponding to a z-score increase of 0.24/year (no mismatch group), 0.21/year (reduction plasty group) and 0.34/year (Ross-Konno group). At the last follow-up, sinotubular junction z-scores were 2.8 ± 1, 3 ± 1 and 2.4 ± 0.9 in the no mismatch, reduction plasty, and Ross-Konno groups, respectively. Ninety-three percent of patients presented with none-to-mild autograft valve regurgitation. The Ross-Konno group showed a significant increase in aortic annulus size (z-score of the annulus at the last follow-up 3.6 ± 1.6; P = 0.036). The no mismatch and the reduction plasty groups showed z-scores within the normal range (2.1 ± 1.7 and 2.5 ± 1.6, respectively).
CONCLUSIONS
Additional aortic annulus reduction or enlargement does not disturb the structural and functional durability of the autograft at the mid-term follow-up. Long-term autograft integrity, especially in the Ross-Konno group, remains to be investigated.
Do surgical modifications at the annular level (e.g. the modified Ross-Konno procedure or reduction plasty) influence the structure and function of the Ross autograft at the mid-term follow-up?
METHODS
From June 2001 to July 2009, 49 patients (37 men and 12 women), mean age 10.5 ± 5.7 years (range 2 weeks to 17.8 years), underwent Ross operations. Twenty-one patients underwent additional aortic annulus reduction plasty and 9 patients a modified Ross-Konno procedure. The need for reintervention, reoperation and valve function were retrospectively analysed for a mean follow-up of 4.6 ± 2.7 years (range 9 days to 9.2 years).
RESULTS
There were no intraoperative or early death. Three late deaths occurred. Survival at 4 years was 91.9 ± 4.6%. In the overall cohort, aortic annular growth was 1 mm/year, corresponding to a z-score increase of 0.24/year (no mismatch group), 0.21/year (reduction plasty group) and 0.34/year (Ross-Konno group). At the last follow-up, sinotubular junction z-scores were 2.8 ± 1, 3 ± 1 and 2.4 ± 0.9 in the no mismatch, reduction plasty, and Ross-Konno groups, respectively. Ninety-three percent of patients presented with none-to-mild autograft valve regurgitation. The Ross-Konno group showed a significant increase in aortic annulus size (z-score of the annulus at the last follow-up 3.6 ± 1.6; P = 0.036). The no mismatch and the reduction plasty groups showed z-scores within the normal range (2.1 ± 1.7 and 2.5 ± 1.6, respectively).
CONCLUSIONS
Additional aortic annulus reduction or enlargement does not disturb the structural and functional durability of the autograft at the mid-term follow-up. Long-term autograft integrity, especially in the Ross-Konno group, remains to be investigated.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/icvts/ivy135
- PMID 29771343
- Persistent URL
- https://sonar.ch/global/documents/66646
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