Pulmonary Autograft (Ross) Operation for Aortic Valve Disease and Pericardial Collar Technique

PURPOSE
Technical demands of the Ross operation and two valves at risk have delayed acceptance. Its inercasing popularity in 90's was due to excellent long term results. The results of 18 consecutive patients who underwent Ross procedure and pericardial collar technique for right ventricular outflow tract reco ns truction (RVOT) was documented in this article. Materials and
METHODS
Patient's ages ranged from 9 to 37 years (mean 16,2 ± 7,1). Three of them had prior open heart operation. Total root replacement technique was used in all patients. Aortoplasty were done in two patients with aortic root dilatation. Ross 1 Konno procedure was performed in 3 patients with subaortic stenosis and/or aortic root hypoplasia. We used homografts in 6 patients and stentless bio pros thes is in 12 patie nts for R VOT reconstructions. A special pericardial collar technique was employed to control some persistent bleeding from septal dissection site and to avoid damage to first septal artery. Additicnal mitral valve replacement was performed in one patient.
RESULTS
One patient died in early postoperative period due to low cardiac output. Comple te atrioventricular block was occurred in one patient and permanent pacemaker implantation was performed. A patient who undergone Ross and MVR, was reoperated owing to endocarditis. Other patients had uneventful postoperative course. Mean follow-up period was 15,2 ± 9 months (1 to 32 months) and all patients were well and in NYHA c lass I or II . Ro utine pos tope rative echocardiographic examinations showed normal aortic valve function or trivial aortic insufficiency (AI) in all but one patient who had mild to moderate Al.
CONCLUSION
The Ross operation could be an alternative procedure for the presthetic aortic valve replacement in selected patients such as children, young adults and females. We think that pericardial collar tec hni que is a useful modif ication and stentless bioprosthesis may be a good alternative to homografts for RVOT reconstruction.