Modified Ross procedure using a conduit with a synthetic valve.
OBJECTIVE
In the Ross procedure, a homograft conduit is commonly used in place of an autotransplanted pulmonary valve. Homograft availability may be a problem and has resulted in a search for alternatives. We performed a modified Ross procedure for right ventricular outflow tract reconstruction with a synthetic valved conduit as an alternative to homograft. Our early results of valvular and right ventricular function were evaluated in patients who used a conduit with a synthetic valve.


METHODS
Subjects consisted of 11 patients, who ranged in age from 5 to 22 years (12.0+/-4.9), and whose body weight ranged from 15.1 to 52.5 (34.3+/-14.4) kg. Indications for surgery were aortic stenosis (n=3), aortic stenosis and regurgitation (n=4), and aortic regurgitation (n=4). Right ventricular outflow tract reconstruction was performed using a hand-fashioned valved conduit prepared by sewing a 0.1 mm thick polytetrafluoroethylene sheet onto the luminal cavity of the 20-28 mm conduit. A conduit made with polytetrafluoroethylene was used in 8 patients, and a Dacron graft was used in 3 patients.


RESULTS
There was no in-hospital or late mortality and angiocardiography at discharge revealed that all artificial valves remained active. The mean right atrial pressure and right ventricular end-diastolic pressure were not statistically different from preoperative values. The latest echocardiography (mean interval, 12.6 months) revealed that a mean pressure gradient across the synthetic valve was 11.4+/-11.1 mmHg and none of the patients had moderate or severe regurgitation.


CONCLUSIONS
We demonstrated that a modified Ross procedure for right ventricular outflow tract reconstruction using a conduit with an appropriate synthetic valve is particularly effective in older children.
Takabayashi
Shin
S
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 2-5-1 Tojin-machi, Chuo-ku, Fukuoka 810-0063, Japan. shin1111@clin.medic.mie-u.ac.jp
Kado
Hideaki
H
Shiokawa
Yuichi
Y
Fukae
Kouji
K
Nakano
Toshihide
T
D000293:Adolescent; D000328:Adult; D000790:Angiocardiography / Q000379:methods; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D011138:Polytetrafluoroethylene; D011184:Postoperative Period; D011664:Pulmonary Valve / Q000637:transplantation; D012086:Reoperation; D016278:Ventricular Function, Right / Q000502:physiology
D011138:Polytetrafluoroethylene