Analysis of 92 mitral pulmonary autograft replacement (Ross II) operations.
OBJECTIVE
The study objective was to find a mitral valve substitute that does not require lifelong anticoagulation and is not affected by tissue degeneration in the long term.


METHODS
Between July 14, 1997, and August 8, 2004, a total of 92 patients with irreparable mitral valve disease underwent mitral valve replacement with the pulmonary autograft encased within a Dacron tubing for support. In 4 patients, the autograft had to be sacrificed at the initial operation. Of the remaining 88 patients, 62 were female, and the age ranged from 4 to 64 years (mean 39 years). Eighty-six patients had rheumatic mitral disease, and 2 patients had congenital mitral disease.


RESULTS
Operative transesophageal echocardiography initially showed adequate valve characteristics (mean valve area 2.8 cm2, mean gradient 3.9 mm Hg, no significant regurgitation) in all 88 patients. Operative mortality was 4.6%, and late mortality definitely related to the operation was 7.9%. Four patients were lost to follow-up; the mean follow-up was 60 months. Progressive regurgitation and stenosis developed in 9 patients over 2 to 5 years, 4 of whom had their grafts explanted. The autograft was explanted in 1 patient because of endocarditis. Mild pulmonic stenosis developed in 3 patients, and critical pulmonic stenosis developed in 1 patient. At 5 years follow-up, freedom from degeneration was 93.4%, freedom from reoperation was 94.2%, and freedom from all death was 86.0%.


CONCLUSIONS
Although the Ross II operation is difficult and harbors significant risk, it remains an option for patients with irreparable mitral disease who have a long life expectancy and who cannot be placed on lifelong anticoagulation.
Kabbani
Sami
S
Damascus University Cardiovascular Surgical Center, Mezza, Damascus, Syria. dam-uncv@net.sy
Jamil
Hisham
H
Nabhani
Fawzi
F
Hamoud
Abdo
A
Katan
Karam
K
Sabbagh
Nada
N
Koudsi
Abir
A
Kabbani
Loay
L
Hamed
Ghiath
G
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D011093:Polyethylene Terephthalates