ABSTRACT
BACKGROUND: A review of a 10-year experience with the Ross procedure as a root replacement by a single group of surgeons featuring specific highlights is presented. Highlights include our results from a subset of patients with endocarditis and their management and a comparison of outcomes in patients with aortic insufficiency based on technical changes made after 5 years' experience. METHODS: The total patient group was 191, with 148 male and 43 female participants with an age range from 1 day to 69 years. Five of the patients in the 0-to-20 age group were newborns. Fifty-three of the adults were operated on for infectious endocarditis. In the total patient group 43% had aortic insufficiency, 28% had aortic stenosis, and 29% had mixed disease. RESULTS: Operative mortality was 5.2% with a late mortality of 2.6%. The actuarial survival was 90.2% at 10 years. Freedom from autograft explantation was 93.2% and freedom from homograft replacement was 98.4%. The endocarditis patients had an operative mortality of 3.8% with 100% cure of the infection. Freedom from reinfection on the autograft was 98.1%, and freedom from infection of the pulmonary homograft was 98.1%. The actuarial survival was 86.3%. CONCLUSIONS: A specific review of the patients with aortic insufficiency resulted in a failure of the autograft in 7 patients among a cohort of 41 during the first 5 years of the study. After a change in technique in which the aortic annulus is narrowed and fixed to a measured size to match the body surface area, we have had no failures in the autograft. Although these results are early, we believe that these data support the use of the autograft as an excellent choice for replacement of the aortic valve in infective endocarditis. Finally, the use of the autograft for aortic insufficiency is reasonable with fixation of the aortic annulus so that subsequent dilation does not occur.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Endocarditis, Bacterial/surgery , Heart Valves/transplantation , Adolescent , Adult , Aged , Aortic Valve Insufficiency/mortality , Aortic Valve Stenosis/mortality , Cause of Death , Child , Child, Preschool , Endocarditis, Bacterial/mortality , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Middle Aged , Survival Rate , Suture Techniques , Transplantation, Autologous , Transplantation, HomologousABSTRACT
A 9-year-old 3-kg spayed Maltese with congestive heart failure that did not respond to aggressive medical treatment underwent cardiopulmonary bypass and mitral valve repair. Prior to surgery, echocardiography revealed a markedly dilated mitral annulus, left atrium, and left ventricle; prolapse of the parietal mitral valve leaflet; and mitral regurgitation. Hilar pulmonary edema was evident on thoracic radiographs. After surgery, echocardiographic measurements of the heart returned to reference range, all medication was discontinued, and the dog did not have clinical signs of heart disease.
Subject(s)
Dog Diseases/surgery , Heart Failure/veterinary , Mitral Valve Insufficiency/veterinary , Mitral Valve/surgery , Animals , Dog Diseases/etiology , Dogs , Female , Heart Failure/etiology , Heart Failure/surgery , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/surgerySubject(s)
Cardiomyopathies/diagnostic imaging , Cardiomyopathies/etiology , Echocardiography, Transesophageal , Hypereosinophilic Syndrome/complications , Hypereosinophilic Syndrome/diagnostic imaging , Cardiomyopathies/physiopathology , Disease Progression , Fatal Outcome , Humans , Hypereosinophilic Syndrome/physiopathology , Male , Middle AgedABSTRACT
The excellent clinical results with homografts inserted for aortic endocarditis encouraged us to take this method one step further, believing that the placement of a pulmonary autograft which is totally viable and antibiotic-perfused would be an even better choice for valve replacement. We applied this technique in 13 consecutive patients with infective aortic endocarditis, achieving excellent early results. Our follow up extending to 30 months continues to show excellent results with 0% re-infection and 0% mortality. We conclude from our experience that this technique affords excellent results in curing the infection with the lowest chance of thromboembolism, the lack of need for anticoagulation and only a small chance of reoperation in the future.
