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Lookup NU author(s): Iain McPherson, Dr Katrijn Jansen, Dr Louise Coats, Dr Justyna Rybicka, Dr David Crossland, Mohamed Nassar
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© The Author(s) 2024.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.
Author(s): Generali T, McPherson I, Visan AC, Mohamed A, Salem MI, Jansen K, Coats L, Rybicka J, Crossland D, Hasan A, Nassar M
Publication type: Article
Publication status: Published
Journal: World Journal for Pediatric and Congenital Heart Surgery
Year: 2024
Pages: epub ahead of print
Online publication date: 07/05/2024
Acceptance date: 08/02/2024
ISSN (print): 2150-1351
ISSN (electronic): 2150-136X
Publisher: SAGE Publications Inc.
URL: https://doi.org/10.1177/21501351241237091
DOI: 10.1177/21501351241237091
PubMed id: 38715391
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