المتخصصون في المجالات الطبية

Overview

Juan A. Crestanello, M.D., is a cardiovascular surgeon and department chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Dr. Crestanello, who specializes in surgery for valvular heart disease, discusses complexity and outcome of re-operation after the Ross procedure in the current era.

JUAN A. CRESTANELLO: You have a patient who has a failed Ross operation. You'd like to know the common reasons for failure, the procedure performed, and the outcomes of the re-operations. This article will answer your questions.

I'm Dr. Juan Crestanello, and this is the Cardiovascular Surgery Series. I will review today the article entitled Complexity and outcome of re-operations after the ross procedure in the current era. The Ross procedure is increasingly used. However, data on Ross patients who require re-operation as well as their long-term outcomes remain limited.

We reviewed 105 patients who had re-operations after the Ross procedure in our clinic. The most common indications for surgery included autograft regurgitation, either isolated or associated with root aneurysm or with RV to PA conduit pathology. Isolated RV to PA conduct pathology was seen in almost 20% of the patients.

Multiple procedures were common. Aortic valve and root replacement was performed in three quarters of the patients. Pulmonary valve or conduit replacement was performed in half. Double root replacement was performed in 11 patients, and ascending aorta and arch replacement was performed in a third of the patients.

The operative mortality was 5%. During a median follow up of 6.25 years, the rate of re-intervention was 18%. The rate of death was 13%.

We concluded that re-operations after the Ross procedure are performed for a wide variety of reasons, with the majority of the patients operated due to autograft dysfunction. Re-operations are complex, with multiple procedures performed in each patient.

These operations can be accomplished with excellent outcomes if performed in centers of excellence with expertise in these complex procedures. Thank you for listening to the Cardiovascular Surgery Series.