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The Ross Operation

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Abstract

The search for an ideal biological heart valve substitute has been going on for half a century. In 1960, Lower and Shumway described the feasibility of replacing the aortic valve in dogs with a native pulmonary valve (Lower et al. J Thorac Cardiovasc Surg 39:680–7, 1960). Further experimental work in Oxford was carried out by Gunning and Duran (Oury et al. Ann Thorac Surg 66:S162–5, 1998). In London, Ross had already pioneered the homograft clinically in 1962, but it had become clear that a valve taken from a deceased person would have a limited durability. To use the pulmonary valve, which has the same embryological origin as the aortic valve and is a living autologous valve substitute, was a groundbreaking idea.

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References

  1. Lower RR, Stoffer RC, Shumway NE. Autotransplantation of the pulmonary valve into the aorta. J Thorac Cardiovasc Surg. 1960;39:680–7.

    CAS  PubMed  Google Scholar 

  2. Oury JH, Hiro SP, Maxwell JM, Lamberti JJ, Duran CM. The Ross procedure: current registry results. Ann Thorac Surg. 1998;66:S162–5.

    Article  CAS  Google Scholar 

  3. Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet. 1967;2:956–8.

    Article  CAS  Google Scholar 

  4. Ross DN. Homograft replacement of the aortic valve. Lancet. 1962;2:487.

    Article  CAS  Google Scholar 

  5. Dagun P, Green GR, Nistal FJ. Deformational dynamics of the aortic root: modes and physiological determinant. Circulation. 1999;100:1154–62.

    Article  Google Scholar 

  6. El-Hamamsy I, Balachandran K, Yacoub MH. Endothelium-dependent regulation of the mechanical properties of the aortic valve cusps. J Am Coll Cardiol. 2009;53:1448–55.

    Article  CAS  Google Scholar 

  7. Stelzer P, Jones DJ, Elkins RC. Aortic root replacement with pulmonary autograft. Circulation. 1989;80:lll209–13.

    Google Scholar 

  8. Yacoub M, Nerem R. Introduction. Bioengineering the heart. Philos Trans R Soc Lond B Biol Sci. 2007;362:1253–5.

    Article  Google Scholar 

  9. Charitos EI, Hanke T, Stierle U, Robinson DR, Bogers AJ, Hemmer W, et al.; German-Dutch Ross Registry.Autograft reinforcement to preserve autograft function after the Ross procedure: a report from the German-Dutch Registry. Circulation. 2009;120:S146–54.

    Article  Google Scholar 

  10. Brown JW, Ruzmetov M, Shahriari A, Rodefield MD, Mahomed Y, Turrentine MW. Mid-term results of Ross aortic valve replacement: a single institution experience. Ann Thorac Surg. 2009;88:601–7.

    Article  Google Scholar 

  11. David TE, Omran A, Ivanov J, Armstrong S, deSa MP, Sonnenberg B, Webb G. Dilatation of the pulmonary autograft after the Ross procedure. J Thorac Cardiovasc Surg. 2000;119:210–20.

    Article  CAS  Google Scholar 

  12. Kouchoukos NT, Masetti P, Nickerson NJ, Castner CF, Stannon WD, Devila-Romain VG. The Ross procedure: long-term clinical and echocardiographic follow-up. Ann Thorac Surg. 2004;78:773–81.

    Article  Google Scholar 

  13. Sievers HH, Hanke T, Stierle U, Bechtel MF, Graf B, Robinson DR, Ross DN. A critical re-appraisal of the Ross operation: renaissance of the sub-coronary implantation technique? Circulation. 2006;114:S504–11.

    Article  Google Scholar 

  14. Sievers HH, Stierle U, Charitos EI, Hanke T, Gorski A, Misfeld M, Bechtel M. Fourteen years’ experience with 501 sub-coronary Ross procedures: surgical details and results. J Thorac Cardiovasc Surg. 2010;140:816–22.

    Article  Google Scholar 

  15. Takkenberg JJ, Klieverik LMA, Schoot PH, van Suylen PJ, van Herwerden LA, Zondervan PE, Roos-Hesselink JW, Eijkemanns MJC, Yacoub MH, Bogers AJJC. The Ross procedure: a systematic review and meta-analysis. Circulation. 2009;119:222–8.

    Article  Google Scholar 

  16. David TE. Ross procedure at the crossroads. Circulation. 2009;119:207–9.

    Article  Google Scholar 

  17. Klieverik LM, Takkenberg JJ, Bekkers JA, Roos-Hesselink JW, Witsenburg M, Bogers AJ. The Ross operation: a Trojan horse? Eur Heart J. 2007;28:1993–2000.

    Article  Google Scholar 

  18. Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16 year experience. J Thorac Cardiovasc Surg. 2008;136:623–30.

    Article  Google Scholar 

  19. Gerestein CG, Takkenberg JJ, Oei FB, Cromme-Dijkhuis AH, Spitaels SE, van Herwerden LA, Steyerberg EW, Bogers AJ. Right ventricular outflow tract reconstruction with an allograft conduit. Ann Thorac Surg. 2001;71:911–7.

    Article  CAS  Google Scholar 

  20. Hogan PG, O’Brien MF. Improving the allograft valve: dose the immune response matter? J Thorac Cardiovasc Surg. 2003;126:1251–3.

    Article  Google Scholar 

  21. Rabkin-Aikawa E, Aikawa M, Farber M, Kraz JR, Garcia-Cardena CG, Kouchoukos NT. Clinical pulmonary autograft valves: pathologic evidence of adaptive modelling in the aortic site. J Thorac Cardiovasc Surg. 2004;128:552–61.

    Article  Google Scholar 

  22. Schoof PH, Takkenberg JJ, van Suylen RJ, Zondervan PE, Hazekamp MG, Dion RA. Degeneration of the pulmonary autograft: an explant study. J Thorac Cardiovasc Surg. 2006;132:1426–32.

    Article  Google Scholar 

  23. Grotenhuis HB, Westenberg JJ, Doornbos J, Kroft IJ, Schoof PH, Hazekamp MG, Vliegen HW, Ottenkamp J, de Roos A. Aortic root dysfunctioning and its effect on left ventricular function in Ross procedure patients assessed with magnetic resonance imaging. Am Heart J. 2006;152:971–8.

    Article  Google Scholar 

  24. Treasure T, Hasan A, Yacoub M. Is there a risk in avoiding risk for younger patients with aortic valve disease? Br Med J. 2011;342:d2466.

    Article  Google Scholar 

  25. Royston G. Commentary: trials versus models in appraising screening programmes. Br Med J. 1999;318:360–1.

    CAS  Google Scholar 

  26. Takkenberg JJ, Puvimanasinghe JP, Grunkemeier GL. Simulation models to predict outcome after aortic valve replacement. Ann Thorac Surg. 2003;75:1372–6.

    Article  Google Scholar 

  27. Stoica S, Goldsmith K, Demiris N, Punjabi P, Berg G, Sharples L. Microsimulation and clinical outcomes analysis support a lower age threshold for the use of biological valves. Heart. 2010;96:1730–6.

    Article  Google Scholar 

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Correspondence to John R. Pepper .

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Pepper, J.R. (2019). The Ross Operation. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_54

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  • DOI: https://doi.org/10.1007/978-3-7091-4874-7_54

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-4872-3

  • Online ISBN: 978-3-7091-4874-7

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