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Journal of the American College of... Dec 2018The ideal aortic valve substitute for young and middle-aged adults remains elusive. The Ross procedure (pulmonary autograft replacement) is the only operation that... (Review)
Review
The ideal aortic valve substitute for young and middle-aged adults remains elusive. The Ross procedure (pulmonary autograft replacement) is the only operation that allows replacement of the diseased aortic valve with a living substitute. However, use of this procedure has declined significantly due to concerns over increased surgical risk and potential long-term failure of the operation. Several recent publications from expert centers have shown that in the current era, the Ross procedure can be performed safely and reproducibly in appropriately selected patients. Furthermore, an increasing body of evidence suggests that the Ross procedure is associated with better long-term outcomes compared with conventional aortic valve replacement in young and middle-aged adults. In this paper, the authors review the indications and technical considerations of the Ross procedure, describe its advantages and drawbacks, and discuss patient selection criteria. Finally, the authors provide a comprehensive synthesis of the current Ross published reports to enable cardiologists and surgeons to make appropriate decisions for their patients with aortic valve disease.
Topics: Adult; Aortic Valve Stenosis; Autografts; Cardiac Surgical Procedures; Cardiologists; Humans; Pulmonary Valve; Review Literature as Topic; Surgeons; Transplantation, Autologous
PubMed: 30497563
DOI: 10.1016/j.jacc.2018.08.2200 -
Journal of the American College of... May 2023The impact of pulmonary valve replacement (PVR) on major adverse clinical outcomes in patients with repaired tetralogy of Fallot (rTOF) is unknown.
BACKGROUND
The impact of pulmonary valve replacement (PVR) on major adverse clinical outcomes in patients with repaired tetralogy of Fallot (rTOF) is unknown.
OBJECTIVES
The purpose of this study was to determine whether PVR is associated with improved survival and freedom from sustained ventricular tachycardia (VT) in rTOF.
METHODS
A PVR propensity score was created to adjust for baseline differences between PVR and non-PVR patients enrolled in INDICATOR (International Multicenter TOF Registry). The primary outcome was time to the earliest occurrence of death or sustained VT. PVR and non-PVR patients were matched 1:1 on PVR propensity score (matched cohort) and in the full cohort, modeling was performed with propensity score as a covariate adjustment.
RESULTS
Among 1,143 patients with rTOF (age 27 ± 14 years, 47% PVR, follow-up 8.3 ± 5.2 years), the primary outcome occurred in 82. The adjusted HR for the primary outcome for PVR vs no-PVR (matched cohort n = 524) was 0.41 (95% CI: 0.21-0.81; multivariable model P = 0.010). Full cohort analysis revealed similar results. Subgroup analysis suggested beneficial effects in patients with advanced right ventricular (RV) dilatation (interaction P = 0.046; full cohort). In patients with RV end-systolic volume index >80 mL/m, PVR was associated with a lower primary outcome risk (HR: 0.32; 95% CI: 0.16-0.62; P < 0.001). There was no association between PVR and the primary outcome in patients with RV end-systolic volume index ≤80 mL/m (HR: 0.86; 95% CI: 0.38-1.92; P = 0.70).
CONCLUSIONS
Compared with rTOF patients who did not receive PVR, propensity score-matched individuals receiving PVR had lower risk of a composite endpoint of death or sustained VT.
Topics: Humans; Adolescent; Young Adult; Adult; Pulmonary Valve; Tetralogy of Fallot; Cardiac Surgical Procedures; Propensity Score; Registries; Tachycardia, Ventricular
PubMed: 37225360
DOI: 10.1016/j.jacc.2023.02.052 -
Circulation. Cardiovascular... Oct 2018
Topics: Heart Ventricles; Pulmonary Valve; Stents
PubMed: 30354642
DOI: 10.1161/CIRCINTERVENTIONS.118.007364 -
The Journal of Thoracic and... Feb 2021
Topics: Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Longevity; Pulmonary Valve
PubMed: 32859415
DOI: 10.1016/j.jtcvs.2020.08.003 -
JACC. Cardiovascular Interventions Dec 2020
Topics: Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Stents; Treatment Outcome
PubMed: 33303114
DOI: 10.1016/j.jcin.2020.09.015 -
Texas Heart Institute Journal Jun 2015Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary... (Review)
Review
Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary stenosis, regurgitation, or both have untoward effects on ventricular function and on the clinical status of these patients. To date, all right ventricle-pulmonary artery conduits have had relatively short lifespans. Percutaneous pulmonary valve implantation, although relatively new, will probably reduce the number of operative procedures that these patients will have to undergo over a lifetime. Refinement and further development of this procedure holds promise for the extension of this technology to other patient populations.
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve
PubMed: 26175629
DOI: 10.14503/THIJ-14-4276 -
Multimedia Manual of Cardiothoracic... Dec 2016There are rare situations in which the left ventricular outflow tract cannot be used for systemic output. The Yasui procedure allows leaving the left ventricle as the...
There are rare situations in which the left ventricular outflow tract cannot be used for systemic output. The Yasui procedure allows leaving the left ventricle as the systemic ventricle, but uses the pulmonary valve as the systemic semilunar valve. These videos illustrate the technical aspects of the Yasui procedure.
Topics: Child; Double Outlet Right Ventricle; Heart Septal Defects, Ventricular; Humans; Mitral Valve Stenosis; Pulmonary Valve
PubMed: 28195688
DOI: 10.1510/mmcts.2016.005 -
JACC. Cardiovascular Interventions Mar 2018
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Artery; Pulmonary Valve; Pulmonary Valve Insufficiency
PubMed: 29566800
DOI: 10.1016/j.jcin.2018.02.017 -
The Thoracic and Cardiovascular Surgeon Dec 2022The aim of this study was to evaluate the long-term outcome and freedom from pulmonary valve replacement (PVR) after initial repair of tetralogy of Fallot (TOF).
BACKGROUND
The aim of this study was to evaluate the long-term outcome and freedom from pulmonary valve replacement (PVR) after initial repair of tetralogy of Fallot (TOF).
PATIENTS AND METHODS
The cohort of 306 patients treated between 1980 and 2017 was divided into anatomical subgroups according to the diagnosis of TOF-pulmonary stenosis, TOF-pulmonary atresia and TOF-double outlet right ventricle. Patients were treated with transannular patch (TAP), valve sparing repair (VSR), or conduits from the right ventricle to the pulmonary arteries (RVPA conduits).
RESULTS
There were 21 deaths (6.9%), 14 being hospital deaths (4.6%) after primary correction and four deaths (1.3%) occurred after PVR. One patient died after a non-cardiac operation (0.3%). There were two late deaths (0.7%). During the past 12 years no early mortality has been observed. Ninety-one patients (30.4%) received PVR after a median of 12.1 ± 7.0 years with an early mortality of 4.4% ( = 4) and no late mortality. A significant difference in freedom from reoperation after TAP, VSR, and RVPA-conduits could be identified. Multivariate analysis displayed transannular repair ( = 0.016), primary palliation ( <0.001), the presence of major aortopulmonary collateral arteries (MAPCA; = 0.023), and pulmonary valve -scores < - 4.0 ( = 0.040) as significant risk factors for PVR.
CONCLUSION
TOF repair has a beneficial long-term prognosis with low morbidity and mortality. Pulmonary valve -scores < - 4.0, transannular repair, and presence of MAPCAs are associated with earlier PVR. Non-VSRs and TOF-pulmonary atresia lead to earlier reoperation but have no negative impact on survival.
Topics: Cardiac Surgical Procedures; Humans; Infant; Pulmonary Atresia; Pulmonary Valve; Reoperation; Retrospective Studies; Tetralogy of Fallot; Treatment Outcome
PubMed: 35752174
DOI: 10.1055/s-0042-1749098 -
JACC. Cardiovascular Interventions Sep 2022
Topics: Cardiac Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency; Tetralogy of Fallot; Treatment Outcome
PubMed: 36137693
DOI: 10.1016/j.jcin.2022.05.021