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Failed autograft after the ross procedure in children: management and outcome.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2014 Jul; Vol. 98 (1), pp. 112-8. Date of Electronic Publication: 2014 Apr 12. - Publication Year :
- 2014
-
Abstract
- Background: Autograft dilatation (AD) and aortic insufficiency (AI) after the Ross procedure are the most common causes of late autograft failure. The purpose of this study was to examine the results of valve-sparing root replacement (modified David) and composite root replacement.<br />Methods: We performed a retrospective review of all children (n=78) undergoing a Ross procedure at our Center from 1993 to 2011.<br />Results: Median follow-up was 10 years (1to 18 years). Freedom from autograft reoperation was 94% at 5 years, and 65% at 15 years. Freedom from greater than 2+ autograft AI was 93% at 5 years and 76% at 15 years. Autograft reoperation was necessary in 22 patients, at a median interval of 8.7 years after the original procedure. Indications for reoperation were AI with autograft dilatation in 15 patients, AI without dilatation in 2 patients, and AD without AI in 5 patients. Surgical procedures used at reoperation included valve-sparing root replacement in 14 patients, root replacement either mechanical or biologic valved conduit in 6 patients, and valve replacement in 2 patients. At a mean follow-up of 5.8 years after reoperation, 4 patients from the valve-sparing group underwent second reoperation (valve replacement). Freedom from second autograft reoperation was 71% for patients after a valve sparing procedure and 100% for patients after an aortic valve or root replacement (Bentall procedure) at 5 years.<br />Conclusions: Autograft valve-sparing root replacement and composite aortic root replacement are effective treatments for aortic root dilation and AI after the Ross procedure. The potential of late autograft insufficiency after valve-sparing root replacement warrants annual follow-up.<br /> (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Cardiac Surgical Procedures methods
Child
Child, Preschool
Echocardiography, Doppler, Color
Female
Follow-Up Studies
Graft Rejection diagnosis
Graft Rejection epidemiology
Humans
Illinois epidemiology
Incidence
Infant
Infant, Newborn
Male
Reoperation
Retrospective Studies
Time Factors
Transplantation, Autologous adverse effects
Cardiac Surgical Procedures adverse effects
Forecasting
Graft Rejection surgery
Heart Valve Diseases surgery
Heart Valves transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 98
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24725835
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2014.02.038