Valve sparing aortic root replacement for dilatation of the pulmonary autograft and aortic regurgitation after the Ross procedure.
BACKGROUND
Aortic insufficiency secondary to progressive dilatation of the pulmonary autograft is being recognized with increasing frequency after the Ross procedure. We reviewed our experience with valve-sparing aortic root replacement concomitant with aortic annuloplasty to assess the effectiveness of this approach.


METHODS
Four patients, aged 8 to 27 years, presented with moderate to severe aortic insufficiency associated with progressive root dilatation from 1 to 8 years after a Ross procedure. All patients had 0 to 1+ aortic insufficiency early after the Ross procedure, with a mean maximal sinus diameter of 37 mm (range 30 to 45 mm). At reoperation the maximum diameter of the root ranged from 45 to 55 mm (mean 50 +/- 4 mm). A valve-sparing aortic root replacement with annular reduction was performed. The annulus was decreased from a mean of 27 mm to 23 mm. For the root replacement, 1 patient underwent a standard root remodeling procedure; in the others, a separate piece of scalloped Dacron (C.R. Bard, Haverhill, PA) graft material was used for each sinus to facilitate optimal exposure.


RESULTS
All 4 patients are in New York Heart Association functional class I at a mean follow-up of 6 months. The most recent echocardiography demonstrated 0 to 1+ aortic insufficiency with good left ventricular function. Histology of the excised pulmonary autograft walls demonstrated severe elastin fragmentation.


CONCLUSIONS
Aortic root remodeling with annular reduction is an effective treatment for aortic root dilatation and aortic insufficiency after the Ross operation. This procedure allows correction of aortic insufficiency and avoids the need for a prosthetic valve and anticoagulation.
Ishizaka
Toru
T
Division of Pediatric Cardiovascular Surgery, Section of Cardiac Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Devaney
Eric J
EJ
Ramsburgh
Stephen R
SR
Suzuki
Takaaki
T
Ohye
Richard G
RG
Bove
Edward L
EL
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D004108:Dilatation, Pathologic; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011664:Pulmonary Valve / Q000473:pathology / Q000637:transplantation*; D012086:Reoperation; D014182:Transplantation, Autologous
D011093:Polyethylene Terephthalates