Thorac cardiovasc Surg 2019; 67(01): 014-020
DOI: 10.1055/s-0038-1668595
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

External Prosthetic Reinforcement of the Pulmonary Autograft

Thomas Ratschiller
1  Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Eva Sames-Dolzer
1  Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Wolfgang Schimetta
2  Department of Applied Systems Research and Statistics, Johannes Kepler University, Linz, Austria
,
Michaela Kreuzer
1  Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Hannes Müller
1  Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Andreas Zierer
1  Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Rudolf Mair
1  Department of Cardiac, Vascular and Thoracic Surgery, Kepler University Hospital, Linz, Austria
› Author Affiliations
Further Information

Publication History

16 April 2018

05 July 2018

Publication Date:
28 August 2018 (eFirst)

Abstract

Background Neo-aortic root dilatation accounts for the majority of reoperations needed after the Ross procedure with implantation of the pulmonary autograft as complete root replacement. This study evaluates early results of external prosthetic reinforcement of the autograft.

Methods From July 2015 to October 2017, 16 adolescent and adult patients received a Ross procedure at our department by this technique. A congenital-dysplastic valve was present in 13 patients, including 9 patients with a bicuspid aortic valve. Clinical and echocardiographic follow-up is complete with a mean duration of 19.7 ± 5.8 months.

Results The mean age at operation was 27.1 ± 16.1 years. Mean aortic cross-clamping time was 102 ± 39 minutes. No bleeding complication occurred. The median stay on the intensive care unit was 2 days. In-hospital mortality was 0%. All patients were discharged with no or trivial aortic regurgitation. In one patient both the autograft and homograft were replaced because of endocarditis 3 months after the primary operation, leading to 93.8% freedom from reoperation at 2 years. There were no late deaths during the study period. The latest echocardiography confirmed absence of aortic regurgitation grade >I in all patients. Neo-aortic root diameters remained stable during follow-up.

Conclusion The presented modification of the Ross procedure does not prolong ischemia time, and can be performed with a low operative morbidity and mortality and an excellent early valve function.