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The Ross Procedure

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Aortic Regurgitation

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Abstract

The Ross procedure consists in replacing the diseased aortic valve with the patient’s own pulmonary valve and simultaneous replacement of the pulmonary valve (and root) with a pulmonary homograft (or in some cases a xenograft). Pulmonary autograft in aortic position is a viable valve with excellent haemodynamics, low thromboembolic risk, resistance to infection and growth potential. These features make this procedure an ideal solution in paediatric aortic valve surgery. In adult patients, Ross procedure has been a subject to controversial debate over decades, with concerns raised over its complexity and for the two valves at potential risk in the long term. Current data, however, document superior long-term results, physiological haemodynamics and high quality of life without need of anticoagulation. In the light of these results, Ross procedure is an optimal option for young adults, women planning pregnancy and individuals with adherence to active life-style. A prerequisite for these beneficial outcomes is a meticulous surgical technique, the important details of which are discussed in the chapter.

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References

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

    Article  CAS  PubMed  Google Scholar 

  2. 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, 822.e1–5.

    Article  PubMed  Google Scholar 

  3. 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.

    PubMed  PubMed Central  Google Scholar 

  4. Reece TB, Welke KF, O’Brien S, et al. Rethinking the Ross procedure in adults. Ann Thorac Surg. 2014;97:175–81.

    Article  PubMed  Google Scholar 

  5. Lansac E, Lim HS, Shomura Y, et al. Aortic root dynamics are asymmetric. J Heart Valve Dis. 2005;14:400–7.

    PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  Google Scholar 

  7. Dagum P, Green GR, Nistal FJ, et al. Deformational dynamics of the aortic root: modes and physiologic determinants. Circulation. 1999;100:II54–62.

    CAS  PubMed  Google Scholar 

  8. El-Hamamsy I, Yacoub MH, Chester AH. Neuronal regulation of aortic valve cusps. Curr Vasc Pharmacol. 2009;7:40–6.

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. Chester AH, El-Hamamsy I, Butcher JT, et al. The living aortic valve: from molecules to function. Glob Cardiol Sci Pract. 2014;2014:52–77.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hammermeister K, Sethi GK, Henderson WG, et al. 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.

    Article  CAS  PubMed  Google Scholar 

  12. 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; discussion 433.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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;137:881–886.e5.

    Article  PubMed  Google Scholar 

  15. 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;147:1202–1210; discussion 1210–1.

    Article  PubMed  Google Scholar 

  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(4):1341–6.e1.

    Article  PubMed  Google Scholar 

  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(5):1526–32.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Johnston DR, Soltesz EG, Vakil N, et al. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Ann Thorac Surg. 2015;99:1239–47.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kvidal P, Bergstrom R, Horte LG, et al. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–56.

    Article  CAS  PubMed  Google Scholar 

  21. Glaser N, Jackson V, Holzmann MJ, et al. Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50–69 years. European Heart Journal. 2016;37(34):2658–67.

    Article  PubMed  Google Scholar 

  22. Bouchard D, Mazine A, Stevens L-M, et al. Twenty-year experience with the CarboMedics mechanical valve prosthesis. Ann Thorac Surg. 2014;97:816–23.

    Article  PubMed  Google Scholar 

  23. Aicher D, Holz A, Feldner S, et al. Quality of life after aortic valve surgery: replacement versus reconstruction. J Thorac Cardiovasc Surg. 2011;142:e19–24.

    Article  PubMed  Google Scholar 

  24. Nötzold A, Hüppe M, Schmidtke C, et al. Quality of life in aortic valve replacement: pulmonary autografts versus mechanical prostheses. J Am Coll Cardiol. 2001;37:1963–6.

    Article  PubMed  Google Scholar 

  25. El-Hamamsy I, Poirier N. What is the role of the Ross procedure in today’s armamentarium? Can J Cardiol. 2013;29(12):1569–76.

    Article  PubMed  Google Scholar 

  26. El-Hamamsy I, Eryigit Z, Stevens LM, 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.

    Article  PubMed  Google Scholar 

  27. Takkenberg JJM, Klieverik LMA, Schoof PH, et al. The Ross procedure: a systematic review and meta-analysis. Circulation. 2009;119:222–8.

    Article  PubMed  Google Scholar 

  28. 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 Registry†. Eur J Cardiothorac Surg. 2016;49:212–8.

    Article  PubMed  Google Scholar 

  29. David TE, David C, Woo A, et al. The Ross procedure: outcomes at 20 years. J Thorac Cardiovasc Surg. 2014;147:85–94.

    Article  PubMed  Google Scholar 

  30. da Costa FD, Takkenberg JJ, Fornazari D, et al. Long-term results of the Ross operation: an 18-year single institutional experience. Eur J Cardiothorac Surg. 2014;46:415–22; discussion 422.

    Article  PubMed  Google Scholar 

  31. Andreas M, Seebacher G, Reida E, et al. A single-center experience with the Ross procedure over 20 years. Ann Thorac Surg. 2014;97:182–8.

    Article  PubMed  Google Scholar 

  32. Skillington PD, Mokhles MM, Takkenberg JJ, et al. Twenty-year analysis of autologous support of the pulmonary autograft in the Ross procedure. Ann Thorac Surg. 2013;96:823–9.

    Article  PubMed  Google Scholar 

  33. Mastrobuoni S, de Kerchove L, Solari S, et al. The Ross procedure in young adults: over 20 years of experience in our Institution. Eur J Cardiothorac Surg. 2016;49(2):507–12.

    Article  PubMed  Google Scholar 

  34. Yacoub MH, Klieverik LM, Melina G, et al. An evaluation of the Ross operation in adults. J Heart Valve Dis. 2006;15:531–9.

    PubMed  Google Scholar 

  35. Charitos EI, Stierle U, Hanke T, et al. 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.

    Article  PubMed  Google Scholar 

  36. Pibarot P, Dumesnil JG, Briand M, et al. Hemodynamic performance during maximum exercise in adult patients with the ross operation and comparison with normal controls and patients with aortic bioprostheses. Am J Cardiol. 2000;86:982–8.

    Article  CAS  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. Sievers HH, Stierle U, Charitos EI, et al. Major adverse cardiac and cerebrovascular events after the Ross procedure: a report from the German-Dutch Ross Registry. Circulation. 2010;122:S216–23.

    Article  PubMed  Google Scholar 

  39. Charitos EI, Takkenberg JJ, Hanke T, 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; discussion 821–3.

    Article  PubMed  Google Scholar 

  40. Klieverik LM, Takkenberg JJ, Bekkers JA, et al. The Ross operation: a Trojan horse? Eur Heart J. 2007;28:1993–2000.

    Article  PubMed  Google Scholar 

  41. Hokken RB, Bogers AJ, Taams MA, et al. Does the pulmonary autograft in the aortic position in adults increase in diameter? An echocardiographic study. J Thorac Cardiovasc Surg. 1997;113:667–74.

    Article  CAS  PubMed  Google Scholar 

  42. Nordmeyer J, Lurz P, Tsang VT, et al. Effective transcatheter valve implantation after pulmonary homograft failure: a new perspective on the Ross operation. J Thorac Cardiovasc Surg. 2009;138:84–8.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Forcillo J, Cikirikcioglu M, Poirier N, et al. The Ross procedure: total root technique. Multimed Man Cardiothorac Surg. 2014. pii: mmu018. doi: 10.1093/mmcts/mmu018.

    Article  PubMed  Google Scholar 

  44. Chikwe J, Kamath A, Stelzer P. Ross procedure. Multimed Man Cardiothorac Surg. 2011;2011:mmcts 2009 004176.

    Google Scholar 

  45. de Sa M, Moshkovitz Y, Butany J, et al. 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.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. Brown JW, Ruzmetov M, Shahriari A, et al. The Ross full root replacement in adults with bicuspid aortic valve disease. J Heart Valve Dis. 2011;20:332–9; discussion 340.

    PubMed  Google Scholar 

  48. 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.

    Article  PubMed  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. Wuliya M, Sleilaty G, Di Centa I, et al. An expansible aortic ring to preserve aortic root dynamics after aortic valve repair. Eur J Cardiothorac Surg. 2015;47(3):482–90; discussion 490.

    Article  PubMed  Google Scholar 

  51. Lansac E, Di Centa I, Sleilaty G, et al. An aortic ring: from physiologic reconstruction of the root to a standardized approach for aortic valve repair. J Thorac Cardiovasc Surg. 2010;140:S28–35; discussion S45–51.

    Article  PubMed  Google Scholar 

  52. Vojacek J, Spatenka J, Holubec T, et al. Coroneo extra-aortic annuloplasty ring could stabilize even the pulmonary autograft annulus in a Ross operation. Eur J Cardiothorac Surg. 2013;43:431–3.

    Article  PubMed  Google Scholar 

  53. 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(5):1280–5.e1.

    Article  PubMed  Google Scholar 

  54. Yacoub MH, El-Hamamsy I, Sievers HH, et al. Under-use of the Ross operation—a lost opportunity. Lancet. 2014;384:559–60.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada

    Ismail El-Hamamsy M.D., Ph.D., F.R.C.S.C.

Authors
  1. Ismail El-Hamamsy M.D., Ph.D., F.R.C.S.C.
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Editors and Affiliations

  1. Department of Cardiac Surgery, Charles University in Prague, Hradec Kralove, Czech Republic

    Jan Vojacek

  2. Department of Cardiac Surgery, Charles University in Prague, Hradec Kralove, Czech Republic

    Pavel Zacek

  3. Department of Cardiac Surgery, Charles University in Prague, Hradec Kralove, Czech Republic

    Jan Dominik

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El-Hamamsy, I. (2018). The Ross Procedure. In: Vojacek, J., Zacek, P., Dominik, J. (eds) Aortic Regurgitation. Springer, Cham. https://doi.org/10.1007/978-3-319-74213-7_17

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  • DOI: https://doi.org/10.1007/978-3-319-74213-7_17

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