Mitral Valve Replacement with a Pulmonary Autograft in an Infant

A 76-day-old infant weighing 3.4 kg was referred for surgical intervention for severe mitral valve stenoinsufficiency caused by leaflet fibrosis and calcification. He had experienced a cerebral infarction in the left middle cerebral artery territory, which was deemed attributable to an embolism of a calcified particle from the dysmorphic mitral valve. Because mitral valve replacement using a prosthetic valve was not feasible in this small baby, mitral valve replacement with a pulmonary autograft was performed. After a brief period of extracorporeal membrane oxygenation (ECMO) support, he was weaned from ECMO and was discharged home without further cardiovascular complications.

Aortic Valve Replacement by Pulmonary Autogrbft: Technical Advances and Follow-up.

Background: Autograft is the best choice of graft material in every place especially in cardiac surgery to avoid all type of anti-coagulant related hazard, immunological reactions and considering cost involvement. Study was designed on the basis of above facts. Methods: All patients underwent surgery with standard Cardiopulmonary By-pass under moderate hypothermia using median stemotomy incision. Aortic valve was excised and the right and left coronary buttons were fashioned. Also the pulmonary root was excised. A running suture technique was used to insert the autograft in to the aortic annulus. A pulmonary homograft made by pericardium with three pulmonary valves of appropriate size (22-29 mm) was then inserted. Results: Between July 2001 to July 2002, 30 patients underwent the modified Ross Procedure at La- Pitie Salpitriere Hospital, Paris, France. Out of 30 patients 16 were male and 14 were female with the mean age of 29 years. Indication of operation was aortic stenosis in 6 cases, aortic insufficiency in 9 cases and mixed aortic valve lesion in 15 cases. The mean intra operative cross clamp time was 120 minutes (range: 70-170 minutes), mean cardiopulmonary bypass time was 150 minutes (range: 110- 195 minutes). Postoperativee chocardiogramsr evealed no significant pulmonary or aortic valvular dysfunction. Three patients, early in the series required reopening for post operative bleeding. Overall a mean of 2.5 units of bloods (0-10) were transfused per patient. Atrial fibrillation occurred in 2 patients which wsre managed accordingly. Among 30 patients, there was one perioperative death (3%), one patient was lost to follow-up and one patient refused to late post operative echocardiography. Twenty four caseso ut of the twenty seven patients available for functional follow-up were in NYHA class I, 2 patients in NYHA class II and one patient in NYHA class III. Conclusions: Pulmonary autografts in aortic position give good short-term result but for its long {erm effrcacy and safety needs more study.

Reemplazo valvular aórtico utilizando la cirugía de Ross: 13 años de experiencia / Aortic Valve Replacement Using the Ross Procedure: a 13-Year Experience

Introducción El procedimiento de Ross para el tratamiento de la valvulopatía aórtica se ha utilizado durante décadas. A pesar de sus resultados alentadores, ciertos interrogantes han limitado su uso masivo; su durabilidad es uno de los principales motivos de preocupación. Objetivo Analizar los resultados de la cirugía de Ross en nuestro centro. Material y métodos El presente es un estudio de cohorte retrospectivo. De julio de 1995 a mayo de 2008, 198 pacientes fueron sometidos a cirugía de Ross; en todos ellos se empleó la técnica de reemplazo de la raíz aórtica. Los eventos asociados con la válvula se analizaron con el método de Kaplan-Meier. Para el análisis de las variables se emplearon el log-rank test y el modelo de Cox. Resultados La edad media fue de 39 ± 13 años; el 77% eran hombres. La cirugía fue indicada por estenosis aórtica (58%) e insuficiencia aórtica (42%). La mortalidad hospitalaria fue del 2,5% (5 pacientes). El seguimiento a 10 años fue completo en el 93% para los primeros 165 pacientes. La sobrevida a los 10 años fue del 94,8% (IC 95% 89-98). La libertad de endocarditis a los 10 años fue del 95% (IC 95% 84-98) y la libertad de eventos relacionados con la válvula a los 10 años fue del 91% (IC 95% 86-96). Cinco pacientes requirieron reoperación, 4 de ellos por disfunción del autoinjerto y enfermedad de otras válvulas. Conclusiones La cirugía de Ross es una técnica quirúrgica con una tasa baja de eventos a los 13 años y debe ser considerada para el tratamiento de la enfermedad valvular aórtica en pacientes seleccionados.

Background The Ross procedure has been used for decades for the treatment of aortic valve disease. Despite the promising outcomes of this technique, its limited durability is one of the major drawbacks against its massive indication. Objective To analyze the outcomes of the Ross procedure in our oenter. Material and Methods We conducted a retrospective study in a cohort of patients. From July 1995 to May 2008, 198 patients underwent Ross procedure with aortic root replacement technique. Kaplan-Meier method was used to analyze the events associated with the valve, and the variables were analyzed using the log-rank test and Cox model. Results Mean age was 39± 13 years and 77% were raen. The procedure was indicated due to aortic stenosis (58%) and aortic regurgitation (42%). In-hospital mortality was 2.5% (5 patients). Complete follow-up at 10 years was achieved in 93% of the first 165 patients. Survival at 10 years was 94.8% (95% CI, 89-98) After 10 years, 95% (95% CI, 84-98) of patients did not present endocarditis and 91% (95% CI, 86-96) had no valve-related events. Five patients required reoperation, 4 due to autograft dysfunction and disease of other valves. Conclusions Ross procedure has a low event rate after 13 years and should be considered for the treatment of aortic valve disease in selected patients.