Advertisement

The Ross Procedure

  • Ismail Bouhout
  • Ismail El-HamamsyEmail author
Chapter
  • 11 Downloads

Abstract

The Ross procedure provides a unique opportunity for non-elderly adult patients whose preferences do not align with the outcome provided by mechanical valve replacement. The acceptance of this procedure has been slow because of the technical demands of the operation and the inherent need for reconstruction of the right ventricular outflow tract, thereby placing two valves at risk. The advantages of the autograft valve include growth potential, optimal hemodynamic performance, and freedom from anticoagulation and hemolysis. However, concerns regarding potential dilatation of the autograft, reoperation for autograft dysfunction, and replacement of right ventricular outflow tract conduits persist. Further, doubts have been expressed by others regarding the indications for the Ross operation in patients with a bicuspid aortic valve and with aortic valve insufficiency. This chapter evaluates existing evidence on the safety and efficacy of Ross procedure for adult patients and focuses on technical aspects of the procedure.

Keywords

Aortic valve replacement Pulmonary autograft Pulmonary homograft Right ventricular outflow tract Ross procedure 

References

  1. 1.
    El-Hamamsy I, Eryigit Z, Stevens LM, Sarang Z, George R, Clark L, et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Lancet. 2010;376:524–31.PubMedCrossRefGoogle Scholar
  2. 2.
    David TE, David C, Woo A, Manlhiot C. The Ross procedure: outcomes at 20 years. J Thorac Cardiovasc Surg. 2014;147:85–93.PubMedCrossRefGoogle Scholar
  3. 3.
    Sievers HH, Stierle U, Charitos EI, et al. Fourteen years’ experience with 501 subcoronary Ross procedures: surgical details and results. J Thorac Cardiovasc Surg. 2010;140:816–22. 22 e1-5PubMedCrossRefGoogle Scholar
  4. 4.
    Sharabiani MT, Dorobantu DM, Mahani AS, et al. Aortic valve replacement and the Ross operation in children and young adults. J Am Coll Cardiol. 2016;67:2858–70.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Mazine A, David TE, Rao V, et al. Long-term outcomes of the Ross procedure versus mechanical aortic valve replacement: propensity-matched cohort study. Circulation. 2016;134:576–85.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Ross DN. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet. 1967;2:956–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Skillington PD, Mokhles MM, Wilson W, et al. Inclusion cylinder method for aortic valve replacement utilising the Ross operation in adults with predominant aortic stenosis—99% freedom from re-operation on the aortic valve at 15 years. Glob Cardiol Sci Pract. 2013;2013:383–94.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Reece TB, Welke KF, O'Brien S, Grau-Sepulveda MV, Grover FL, Gammie JS. Rethinking the Ross procedure in adults. Ann Thorac Surg. 2014;97:175–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Hanke T, Stierle U, Boehm JO, Botha CA, Matthias Bechtel JF, Erasmi A, et al. Autograft regurgitation and aortic root dimensions after the Ross procedure: the German Ross Registry experience. Circulation. 2007;116:I251–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Lansac E, Lim HS, Shomura Y, et al. Aortic root dynamics are asymmetric. J Heart Valve Dis. 2005;14:400–7.PubMedGoogle Scholar
  11. 11.
    Lansac E, Lim HS, Shomura Y, et al. A four-dimensional study of the aortic root dynamics. Eur J Cardiothorac Surg. 2002;22:497–503.PubMedCrossRefGoogle Scholar
  12. 12.
    Dagum P, Green GR, Nistal FJ, et al. Deformational dynamics of the aortic root: modes and physiologic determinants. Circulation. 1999;100:II54–62.PubMedGoogle Scholar
  13. 13.
    El-Hamamsy I, Yacoub MH, Chester AH. Neuronal regulation of aortic valve cusps. Curr Vasc Pharmacol. 2009;7:40–6.PubMedCrossRefGoogle Scholar
  14. 14.
    El-Hamamsy I, Balachandran K, Yacoub MH, et al. Endothelium-dependent regulation of the mechanical properties of aortic valve cusps. J Am Coll Cardiol. 2009;53:1448–55.PubMedCrossRefGoogle Scholar
  15. 15.
    Chester AH, El-Hamamsy I, Butcher JT, Latif N, Bertazzo S, Yacoub MH. The living aortic valve: from molecules to function. Glob Cardiol Sci Pract. 2014;2014:52–77.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Bouhout I, Stevens LM, Mazine A, et al. Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults. J Thorac Cardiovasc Surg. 2014;148:1341–46 e1.CrossRefGoogle Scholar
  17. 17.
    Forcillo J, El Hamamsy I, Stevens LM, et al. The perimount valve in the aortic position: twenty-year experience with patients under 60 years old. Ann Thorac Surg. 2014;97:1526–32.CrossRefGoogle Scholar
  18. 18.
    Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the veterans affairs randomized trial. J Am Coll Cardiol. 2000;36:1152–8.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Ruel M, Kulik A, Lam BK, et al. Long-term outcomes of valve replacement with modern prostheses in young adults. Eur J Cardiothorac Surg. 2005;27:425–33.PubMedCrossRefGoogle Scholar
  20. 20.
    Kulik A, Bedard P, Lam BK, et al. Mechanical versus bioprosthetic valve replacement in middle-aged patients. Eur J Cardiothorac Surg. 2006;30:485–91.PubMedCrossRefGoogle Scholar
  21. 21.
    van Geldorp MWA, Eric Jamieson WR, Kappetein AP, et al. Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: weighing lifetime anticoagulant-related event risk against reoperation risk. J Thorac Cardiovasc Surg. 2009;137:881–86.e5.PubMedCrossRefGoogle Scholar
  22. 22.
    Puskas J, Gerdisch M, Nichols D, et al. Reduced anticoagulation after mechanical aortic valve replacement: interim results from the prospective randomized on-X valve anticoagulation clinical trial randomized Food and Drug Administration investigational device exemption trial. J Thorac Cardiovasc Surg. 2014;147:1202–10.CrossRefGoogle Scholar
  23. 23.
    Bourguignon T, El Khoury R, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards Perimount aortic valve in patients aged 60 or younger. Ann Thorac Surg. 2015;100:853–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Johnston DR, Soltesz EG, Vakil N 3rd, et al. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Ann Thorac Surg. 2015;99:1239–47.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Kvidal P, Bergstrom R, Horte LG, Stahle E. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–56.PubMedCrossRefGoogle Scholar
  26. 26.
    Goldstone AB, Chiu P, Baiocchi M, et al. Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement. N Engl J Med. 2017;377:1847–57.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Aicher D, Holz A, Feldner S, Kollner V, Schafers HJ. Quality of life after aortic valve surgery: replacement versus reconstruction. J Thorac Cardiovasc Surg. 2011;142:e19–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Nötzold A, Hüppe M, Schmidtke C, Blömer P, Uhlig T, Sievers H-H. Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses. J Am Coll Cardiol. 2001;37:1963–6.PubMedCrossRefGoogle Scholar
  29. 29.
    El-Hamamsy I, Poirier N. What is the role of the Ross procedure in today’s armamentarium? Can J Cardiol. 2013;29:1569–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Karaskov A, Sharifulin R, Zheleznev S, Demin I, Lenko E, Bogachev-Prokophiev A. Results of the Ross procedure in adults: a single-centre experience of 741 operations. Eur J Cardiothorac Surg. 2016;49:e97–e104.PubMedCrossRefGoogle Scholar
  31. 31.
    David TE, Woo A, Armstrong S, Maganti M. When is the Ross operation a good option to treat aortic valve disease? J Thorac Cardiovasc Surg. 2010;139:68–73.PubMedCrossRefGoogle Scholar
  32. 32.
    Mastrobuoni S, de Kerchove L, Solari S, et al. The Ross procedure in young adults: over 20 years of experience in our Institutiondagger. Eur J Cardiothorac Surg. 2016;49:507–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Charitos EI, Stierle U, Hanke T, Schmidtke C, Sievers HH, Richardt D. Long-term results of 203 young and middle-aged patients with more than 10 years of follow-up after the original subcoronary Ross operation. Ann Thorac Surg. 2012;93:495–502.PubMedCrossRefGoogle Scholar
  34. 34.
    Miskovic A, Monsefi N, Karimian-Tabrizi A, Zierer A, Moritz A. A 17-year, single-centre experience with the Ross procedure: fulfilling the promise of a durable option without anticoagulation? Eur J Cardiothorac Surg. 2016;49:514–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Sievers HH, Stierle U, Charitos EI, et al. A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registrydagger. Eur J Cardiothorac Surg. 2016;49:212–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Martin E, Mohammadi S, Jacques F, Kalavrouziotis D, Voisine P, Doyle D, et al. Clinical outcomes following the Ross procedure in adults: a 25-year longitudinal study. J Am Coll Cardiol. 2017;70:1890–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Mazine A, Rocha RV, El-Hamamsy I, et al. Ross procedure vs mechanical aortic valve replacement in adults: a systematic review and meta-analysis. JAMA Cardiol. 2018;3:978–87.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    McClure GR, Belley-Cote EP, Um K, et al. The Ross procedure versus prosthetic and homograft aortic valve replacement: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2019;55(2):247–55.  https://doi.org/10.1093/ejcts/ezy247.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Doss M, Wood JP, Kiessling AH, Moritz A. Comparative evaluation of left ventricular mass regression after aortic valve replacement: a prospective randomized analysis. J Cardiothorac Surg. 2011;6:136.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Torii R, El-Hamamsy I, Donya M, et al. Integrated morphologic and functional assessment of the aortic root after different tissue valve root replacement procedures. J Thorac Cardiovasc Surg. 2012;143:1422–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Puranik R, Tsang VT, Broadley A, et al. Functional outcomes after the Ross (pulmonary autograft) procedure assessed with magnetic resonance imaging and cardiopulmonary exercise testing. Heart. 2010;96:304–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Takkenberg JJ, Bogers AJ. Allografts for aortic valve and root replacement: veni vidi vici? Expert Rev Cardiovasc Ther. 2004;2:97–105.PubMedCrossRefGoogle Scholar
  43. 43.
    Charitos EI, Takkenberg JJ, Hanke T, Gorski A, Botha C, Franke U, et al. Reoperations on the pulmonary autograft and pulmonary homograft after the Ross procedure: an update on the German Dutch Ross Registry. J Thorac Cardiovasc Surg. 2012;144:813–21.PubMedCrossRefGoogle Scholar
  44. 44.
    Elkins RC, Thompson DM, Lane MM, Elkins CC, Peyton MD. Ross operation: 16-year experience. J Thorac Cardiovasc Surg. 2008;136:623–30. 30 e1-5PubMedCrossRefGoogle Scholar
  45. 45.
    Ryan WH, Prince SL, Culica D, Herbert MA. The Ross procedure performed for aortic insufficiency is associated with increased autograft reoperation. Ann Thorac Surg. 2011;91:64–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Juthier F, Vincentelli A, Pincon C, et al. Reoperation after the Ross procedure: incidence, management, and survival. Ann Thorac Surg. 2012;93:598–604.PubMedCrossRefGoogle Scholar
  47. 47.
    de Sa M, Moshkovitz Y, Butany J, David TE. Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the Ross procedure. J Thorac Cardiovasc Surg. 1999;118:588–96.PubMedCrossRefGoogle Scholar
  48. 48.
    Fedak PW, de Sa MP, Verma S, et al. Vascular matrix remodeling in patients with bicuspid aortic valve malformations: implications for aortic dilatation. J Thorac Cardiovasc Surg. 2003;126:797–806.PubMedCrossRefGoogle Scholar
  49. 49.
    Brown JW, Ruzmetov M, Shahriari A, Rodefeld MD, Turrentine MW, Mahomed Y. The Ross full root replacement in adults with bicuspid aortic valve disease. J Heart Valve Dis. 2011;20:332–9. discussion 40PubMedGoogle Scholar
  50. 50.
    Hanke T, Charitos EI, Stierle U, et al. The Ross operation—a feasible and safe option in the setting of a bicuspid aortic valve? Eur J Cardiothorac Surg. 2010;38:333–9.PubMedCrossRefGoogle Scholar
  51. 51.
    El-Hamamsy I, Yacoub MH. A measured approach to managing the aortic root in patients with bicuspid aortic valve disease. Curr Cardiol Rep. 2009;11:94–100.PubMedCrossRefGoogle Scholar
  52. 52.
    Basmadjian L, Basmadjian AJ, Stevens LM, et al. Early results of extra-aortic annuloplasty ring implantation on aortic annular dimensions. J Thorac Cardiovasc Surg. 2016;151:1280–5 e1.PubMedCrossRefGoogle Scholar
  53. 53.
    Lansac E, Di Centa I, Sleilaty G, et al. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg. 2016;50:350–60.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Takkenberg JJ, van Herwerden LA, Galema TW, et al. Serial echocardiographic assessment of neo-aortic regurgitation and root dimensions after the modified Ross procedure. J Heart Valve Dis. 2006;15:100–6.PubMedGoogle Scholar
  55. 55.
    Carr-White GS, Afoke A, Birks EJ, et al. Aortic root characteristics of human pulmonary autografts. Circulation. 2000;102:III15–21.PubMedCrossRefGoogle Scholar
  56. 56.
    Wisneski AD, Matthews PB, Azadani AN, et al. Human pulmonary autograft wall stress at systemic pressures prior to remodeling after the Ross procedure. J Heart Valve Dis. 2014;23:377–84.PubMedGoogle Scholar
  57. 57.
    Mokhles MM, Kortke H, Stierle U, et al. Survival comparison of the ross procedure and mechanical valve replacement with optimal self-management anticoagulation therapy: Propensity-matched cohort study. Circulation. 2011;123(1):31-8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiac Surgery, Montreal Heart InstituteUniversité de MontréalMontrealCanada

Personalised recommendations