Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-29T19:37:20.889Z Has data issue: false hasContentIssue false
  • English
  • Français

Mechanism of autograft insufficiency after the Ross operation in children

Published online by Cambridge University Press:  31 October 2012

Motohiko Goda ,
Marc Gewillig ,
Benedicte Eyskens ,
Ruth Heying ,
Bjorn Cools ,
Filip Rega  and
Bart Meyns
Motohiko Goda*
Affiliation:
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium Department of Cardiothoracic Surgery, Yokohama City University Hospital, Kanazawa-ku, Yokohama, Japan
Marc Gewillig
Affiliation:
Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
Benedicte Eyskens
Affiliation:
Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
Ruth Heying
Affiliation:
Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
Bjorn Cools
Affiliation:
Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
Filip Rega
Affiliation:
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
Bart Meyns
Affiliation:
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
*
Correspondence to: Dr M. Goda, MD, Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. Tel: +3216344260; Fax: +3216344616; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

It is unclear how autografts grow and dilate after the Ross operation in children. We analysed autograft growth and dilatation in children who underwent the Ross operation and examined the relationship of these factors to autograft failure.

Methods

From our institutional database, we retrospectively identified 33 children who underwent the Ross operation without aortic root reinforcement (mean age 9.9 years) and had normal body measurements and echocardiographic data throughout follow-up.

Results

Autograft insufficiency developed in 10 patients 5.1 years after the Ross operation. The average Z score at the development of autograft insufficiency was −0.1 (range from −2.0 to 6.1). The proportions of patients who remained free of autograft insufficiency at 5 and 10 years were 87.2% and 55.7%, respectively. A consistent trend in the time course of Z score was not found in any age group studied.

Conclusions

Autograft growth and dilation after the Ross operation varied widely among patients, and the incidence of autograft insufficiency was independent of annulus size.

Keywords

Congenital valve diseaseaortic valvepulmonary valvechildZ scoreKaplan–Meier method
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 4 , August 2013 , pp. 523 - 529
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Solymar, L, Südow, G, Holmgren, D. Increase in size of the pulmonary autograft after the Ross operation in children: growth or dilatation? J Thorac Cardiovasc Surg 2000; 119: 4–9.CrossRefGoogle ScholarPubMed
2. David, TE, Omran, A, Armstrong, S. Dilatation of the pulmonary autograft after the Ross procedure. J Thorac Cardiovasc Surg 2000; 119: 210–220.CrossRefGoogle ScholarPubMed
3. Luciani, GB, Casali, G, Favaro, A, et al. Fate of the aortic root late after Ross operation. Circulation 2003; 108 (Suppl 1): II-61–II-67.CrossRefGoogle ScholarPubMed
4. Kouchoukos, NT, Masetti, P, Nickerson, NJ, Castner, CF, Shannon, WD, Dávila-Román, VG. The Ross procedure: long-term clinical and echocardiographic follow-up. Ann Thorac Surg 2004; 78: 773–781.CrossRefGoogle ScholarPubMed
5. Takkenberg, JJ, Klieverik, LM, Schoof, PH, et al. The Ross procedure: a systematic review and meta-analysis. Circulation 2009; 119: 222–228.CrossRefGoogle ScholarPubMed
6. Hörer, J, Stierle, U, Bogers, AJ, et al. Re-intervention on the autograft and the homograft after the Ross operation in children. Eur J Cardiothorac Surg 2010; 37: 1008–1014.CrossRefGoogle ScholarPubMed
7. Bekkers, JA, Klieverik, LM, Raap, GB, Takkenberg, JJ, Bogers, AJ. Aortic root reoperations after pulmonary autograft implantation. J Thorac Cardiovasc Surg 2010; 140 (6 Suppl): S58–S63.CrossRefGoogle ScholarPubMed
8. Charitos, EI, Hanke, T, Stierle, U, et al. Autograft reinforcement to preserve autograft function after the Ross procedure: a report from the German–Dutch Ross Registry. Circulation 2009; 120 (11 Suppl): S146–S154.CrossRefGoogle ScholarPubMed
9. Sievers, HH, Stierle, U, Charitos, EI, et al. Major adverse cardiac and cerebrovascular events after the Ross procedure: a report from the German–Dutch Ross Registry. Circulation 2010; 122 (11 Suppl): S216–S223.CrossRefGoogle ScholarPubMed
10. DuBois, D, DuBois, EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1916; 17: 863–871.CrossRefGoogle Scholar
11. Kaupmann, C, Weithoff, CM, Stolz, G, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000; 83: 667–672.CrossRefGoogle Scholar
12. Hraska, V, Krajci, M, Haun, C, et al. Ross and Ross–Konno procedure in children and adolescents: mid-term results. Eur J Cardiothorac Surg 2004; 25: 742–747.CrossRefGoogle ScholarPubMed
13. Khwaja, S, Nigro, JJ, Starnes, VA. The Ross procedure is an ideal aortic valve replacement operation for the teen patients. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 173–175.CrossRefGoogle Scholar
14. Takkenberg, JJ, Kappetein, AP, van Herwerden, LA, Witsenburg, M, van Osch-Gevers, L, Bogers, AJ. Pediatric autograft aortic root replacement: a prospective follow-up study. Ann Thorac Surg 2005; 80: 1628–1633.CrossRefGoogle ScholarPubMed
15. Böhm, JO, Botha, CA, Horke, A, et al. Is the Ross operation still an acceptable option in children and adolescents? Ann Thorac Surg 2006; 82: 940–947.CrossRefGoogle ScholarPubMed
16. Stewart, RD, Becker, CL, Hillman, ND, Lundt, C, Mavroudis, C. The Ross operation in children: effects of aortic annuloplasty. Ann Thorac Surg 2007; 84: 1326–1330.CrossRefGoogle ScholarPubMed
17. Hokken, RB, Bogers, AJ, Taams, MA, et al. Does the pulmonary autograft in the aortic position in adults increase in diameter? An echocardiographic study. J Thorac Cardiovasc Surg 1997; 113: 453–461.CrossRefGoogle ScholarPubMed
18. Alsoufi, B, Manlhiot, C, Fadel, B, et al. Is the Ross procedure a suitable choice for aortic valve replacement in children with rheumatic aortic valve disease? World J Pediatr Congenit Heart Surg 2012; 3: 8–15.CrossRefGoogle ScholarPubMed
19. Schoof, PH, Takkenberg, JJ, van Suylen, RJ, et al. Degeneration of the pulmonary autograft: an explant study. J Thorac Cardiovasc Surg 2006; 132: 1426–1432.CrossRefGoogle ScholarPubMed
20. de Sa, M, Moshkovitz, Y, Butany, J, David, TE. Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure. J Thorac Cardiovasc Surg 1999; 118: 588–594.CrossRefGoogle ScholarPubMed