The Heart Valve Society

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Modified Ross procedure to prevent autograft dilatation: A 5-year experience
Saadallah TAMER, MD, Laurent De Kerchove, MD, PhD, Jawad Hechadi, MD, Philippe Noirhomme, MD, Parla Astarci, MD, PhD, Gebrine El Khoury, MD.
Cliniques Universitaires St-Luc, Woluwe-Saint-Lambert, Belgium.

OBJECTIVE:
The Ross procedure is an attractive alternative to aortic valve replacement in young adults. Dilatation of the pulmonary autograft limits the long-term durability mainly in BAV patients; therefore, inclusion of the autograft into a vascular graft has been recently proposed. We analyzed our experience with this technique.
METHODS: From 1991 to 2016, 424 patients underwent a Ross operation in our institution. Autograft inclusion into a vascular graft (straight graft, n=2; Valsalva, n=36; Cardioroot, n=27) was performed since 2011 in patients with aortic annulus or root dilatation in 65 patients. 57 of those patients (88%) had bicuspid aortic valve. Dilated ascending aorta was replaced in 26 patients (40%). Mean root diameter was 38 8 mm (28 to 65). Mean age was 45 years and 92,3% were male. Clinical and transthoracic echocardiographic follow-up was obtained to assess autograft function and neo-aortic root diameters.
RESULTS: There was no hospital mortality. Two patients required early reoperation (3%), of which one required valve replacement and in the other, the autograft was preserved. One patient presented with transient ischemic attack during the postoperative period. During follow-up, no patients died, and 3 patients needed reoperation (2 for autograft prolapse repair and 1 for homograft replacement). All patients were in NYHA class 1 or 2 and none presented endocarditis. Freedom from late homograft and/or autograft reoperation at 4 years was 91.6%. Echocardiography showed no autograft regurgitation in 20 (30.7%) patients, grade 1 autograft regurgitation in 39 (60%) and grade 2 in five (7,7%). The average peak gradient through the autograft was 7 mmHg. Aortic root diameter was at 31.6 3 mm.
CONCLUSIONS: The modified Ross operation with autograft inclusion into a vascular graft is feasible and safe. The mid-term results show preserved autograft function and stability of the neo-aortic root. Long-term follow-up is still required to prove the potential this technique could offer in lifelong durability of the pulmonary autograft and preservation of its function.


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