Semilunar valve switch procedure

Autotransplantation of the native aortic valve to the pulmonary position in the Ross procedure

Patrick Roughneen, Serafin Y. DeLeon, Benjamin W. Eidem, Neil J. Thomas, Frank Cetta, Dolores A. Vitullo, Kathy E. Magliato, Teresa E. Berry, Mamdouh Bakhos

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background. The Ross procedure has gained wide acceptance in young patients with aortic valve disease. The durability of the pulmonary autograft in the aortic position has been proved, with up to 24 years of follow-up. The homograft pulmonary valve, however, has limited longevity. To circumvent this problem we harvested, repaired, and reimplanted the native aortic valve with intact commissures in the pulmonary position in 13 patients undergoing the Ross procedure for aortic insufficiency. Methods. The cause of aortic insufficiency was rheumatic in 6 patients, congenital in 4, post-aortic valvotomy in 2, and bacterial endocarditis in 1. Patient age ranged from 5 to 45 years (mean, 17 ± 9 years). Root replacement technique with coronary artery reimplantation was used. In the first 4 patients, the native aortic valve was sutured into the right ventricular outflow tract, and a polytetrafluorethylene patch was used to reconstruct the main pulmonary artery. In the last 9 patients, the aortic valve and polytetrafluorethylene patch were made into a conduit by another surgeon while the left-sided reconstruction was performed. Results. All patients had marked reduction of left ventricular dilation and good function of the reimplanted native aortic valve, with up to 50 months of follow-up (mean, 29.9 ± 14.2 months; range, 12 to 50 months). Two patients died 15 and 26 days, respectively, of a false aneurysm rupture at the distal aortic anastomosis. In the remaining 11 patients, 9 (82%) had mild or absent, and 2 (18%) had mild to moderate, neoaortic valve regurgitation. Similarly, 9 patients (82%) had mild or absent, and 2 (18%) had mild to moderate, neopulmonary valve regurgitation. Mild neopulmonary valve stenosis was present in 6 patients (54%) (mean gradient, 29 ± 4 mm Hg; range, 25 to 35 mm Hg). All surviving patients are in functional New York Heart Association functional class I. Conclusions. We conclude that use of the native aortic valve with the Ross procedure makes the procedure attractive and potentially curative. The diseased aortic valve works well in the pulmonary position because of lower pressure and resistance. The valve leaflets should remain viable and grow in both the pulmonary and aortic positions because they derive nutrition directly from the blood.

Original languageEnglish (US)
Pages (from-to)745-750
Number of pages6
JournalAnnals of Thoracic Surgery
Volume67
Issue number3
DOIs
StatePublished - Mar 1999
Externally publishedYes

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Autologous Transplantation
Aortic Valve
Lung
Bacterial Endocarditis
Pulmonary Valve
Aortic Diseases
Replantation
False Aneurysm
Autografts
Pulmonary Artery
Allografts
Rupture
Dilatation
Coronary Vessels
Pathologic Constriction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Semilunar valve switch procedure : Autotransplantation of the native aortic valve to the pulmonary position in the Ross procedure. / Roughneen, Patrick; DeLeon, Serafin Y.; Eidem, Benjamin W.; Thomas, Neil J.; Cetta, Frank; Vitullo, Dolores A.; Magliato, Kathy E.; Berry, Teresa E.; Bakhos, Mamdouh.

In: Annals of Thoracic Surgery, Vol. 67, No. 3, 03.1999, p. 745-750.

Research output: Contribution to journalArticle

Roughneen, Patrick ; DeLeon, Serafin Y. ; Eidem, Benjamin W. ; Thomas, Neil J. ; Cetta, Frank ; Vitullo, Dolores A. ; Magliato, Kathy E. ; Berry, Teresa E. ; Bakhos, Mamdouh. / Semilunar valve switch procedure : Autotransplantation of the native aortic valve to the pulmonary position in the Ross procedure. In: Annals of Thoracic Surgery. 1999 ; Vol. 67, No. 3. pp. 745-750.
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T2 - Autotransplantation of the native aortic valve to the pulmonary position in the Ross procedure

AU - Roughneen, Patrick

AU - DeLeon, Serafin Y.

AU - Eidem, Benjamin W.

AU - Thomas, Neil J.

AU - Cetta, Frank

AU - Vitullo, Dolores A.

AU - Magliato, Kathy E.

AU - Berry, Teresa E.

AU - Bakhos, Mamdouh

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N2 - Background. The Ross procedure has gained wide acceptance in young patients with aortic valve disease. The durability of the pulmonary autograft in the aortic position has been proved, with up to 24 years of follow-up. The homograft pulmonary valve, however, has limited longevity. To circumvent this problem we harvested, repaired, and reimplanted the native aortic valve with intact commissures in the pulmonary position in 13 patients undergoing the Ross procedure for aortic insufficiency. Methods. The cause of aortic insufficiency was rheumatic in 6 patients, congenital in 4, post-aortic valvotomy in 2, and bacterial endocarditis in 1. Patient age ranged from 5 to 45 years (mean, 17 ± 9 years). Root replacement technique with coronary artery reimplantation was used. In the first 4 patients, the native aortic valve was sutured into the right ventricular outflow tract, and a polytetrafluorethylene patch was used to reconstruct the main pulmonary artery. In the last 9 patients, the aortic valve and polytetrafluorethylene patch were made into a conduit by another surgeon while the left-sided reconstruction was performed. Results. All patients had marked reduction of left ventricular dilation and good function of the reimplanted native aortic valve, with up to 50 months of follow-up (mean, 29.9 ± 14.2 months; range, 12 to 50 months). Two patients died 15 and 26 days, respectively, of a false aneurysm rupture at the distal aortic anastomosis. In the remaining 11 patients, 9 (82%) had mild or absent, and 2 (18%) had mild to moderate, neoaortic valve regurgitation. Similarly, 9 patients (82%) had mild or absent, and 2 (18%) had mild to moderate, neopulmonary valve regurgitation. Mild neopulmonary valve stenosis was present in 6 patients (54%) (mean gradient, 29 ± 4 mm Hg; range, 25 to 35 mm Hg). All surviving patients are in functional New York Heart Association functional class I. Conclusions. We conclude that use of the native aortic valve with the Ross procedure makes the procedure attractive and potentially curative. The diseased aortic valve works well in the pulmonary position because of lower pressure and resistance. The valve leaflets should remain viable and grow in both the pulmonary and aortic positions because they derive nutrition directly from the blood.

AB - Background. The Ross procedure has gained wide acceptance in young patients with aortic valve disease. The durability of the pulmonary autograft in the aortic position has been proved, with up to 24 years of follow-up. The homograft pulmonary valve, however, has limited longevity. To circumvent this problem we harvested, repaired, and reimplanted the native aortic valve with intact commissures in the pulmonary position in 13 patients undergoing the Ross procedure for aortic insufficiency. Methods. The cause of aortic insufficiency was rheumatic in 6 patients, congenital in 4, post-aortic valvotomy in 2, and bacterial endocarditis in 1. Patient age ranged from 5 to 45 years (mean, 17 ± 9 years). Root replacement technique with coronary artery reimplantation was used. In the first 4 patients, the native aortic valve was sutured into the right ventricular outflow tract, and a polytetrafluorethylene patch was used to reconstruct the main pulmonary artery. In the last 9 patients, the aortic valve and polytetrafluorethylene patch were made into a conduit by another surgeon while the left-sided reconstruction was performed. Results. All patients had marked reduction of left ventricular dilation and good function of the reimplanted native aortic valve, with up to 50 months of follow-up (mean, 29.9 ± 14.2 months; range, 12 to 50 months). Two patients died 15 and 26 days, respectively, of a false aneurysm rupture at the distal aortic anastomosis. In the remaining 11 patients, 9 (82%) had mild or absent, and 2 (18%) had mild to moderate, neoaortic valve regurgitation. Similarly, 9 patients (82%) had mild or absent, and 2 (18%) had mild to moderate, neopulmonary valve regurgitation. Mild neopulmonary valve stenosis was present in 6 patients (54%) (mean gradient, 29 ± 4 mm Hg; range, 25 to 35 mm Hg). All surviving patients are in functional New York Heart Association functional class I. Conclusions. We conclude that use of the native aortic valve with the Ross procedure makes the procedure attractive and potentially curative. The diseased aortic valve works well in the pulmonary position because of lower pressure and resistance. The valve leaflets should remain viable and grow in both the pulmonary and aortic positions because they derive nutrition directly from the blood.

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