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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 51-60, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
G Gerosa, R McKay, J Davies and DN Ross
To assess late results of aortic homograft and pulmonary autograft valves
implanted into the left ventricular outflow tract of children, we reviewed
the case histories of 146 patients 18 years of age or younger who underwent
aortic valve or root replacement between November 1964 and April 1990. One
hundred three patients (mean, 12 +/- 3.9 years) received an aortic
homograft and 43 (mean, 14 +/- 4.1 years) had their own pulmonary valve
transferred to the aortic position. There were 54 valve and 49 root
replacements with homografts and 36 valve and seven root replacements with
autografts. Hospital mortality rate was 15.5% (16 patients) in the
homograft group and 11.6% (five patients) in the autograft group. Survivors
were followed up for a total of 867 (homograft) and 297 (autograft)
patient-years. The late mortality rate was 16.7% (1.9% per patient-year)
for patients with homografts and 13.2% (4.4% per patient-year) for patients
with autografts, whereas the incidence for reoperation per patient-year was
2.9% and 2.0%, respectively. At 15 years actuarial rates for homografts and
autografts for freedom from reoperation were 54% +/- 8.1% and 68% +/-
11.1%; freedom from endocarditis, 97% +/- 2.4% and 75% +/- 10.2%; and
freedom from any complication, 41% +/- 6.5% and 50% +/- 10.3%. Valve
degeneration occurred in 19 homografts (2.2% per patient-year), whereas
there was no definite instance of primary tissue failure among the
pulmonary autografts. This experience would indicate that either the
homograft or the autograft valve can be used with acceptable results in
children. However, the pulmonary autograft gives better long-term
performance and, if growth potential is realized, may be the ideal valve
substitute in children.
ARTICLES
Comparison of the aortic homograft and the pulmonary autograft for aortic valve or root replacement in children
National Heart Hospital, London, England.
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F. M. Lupinetti, B. W. Duncan, M. Lewin, U. Dyamenahalli, and G. L. Rosenthal Comparison of autograft and allograft aortic valve replacement in children J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 240 - 245. [Abstract] [Full Text] [PDF]
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A. Laudito, M. M. Brook, S. Suleman, M. S. Bleiweis, L. D. Thompson, F. L. Hanley, and V. M. Reddy The Ross procedure in children and young adults: A word of caution J. Thorac. Cardiovasc. Surg., July 1, 2001; 122(1): 147 - 153. [Abstract] [Full Text] [PDF]
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C. J. Knott-Craig, R. C. Elkins, K. Santangelo, C. McCue, and M. M. Lane Aortic valve replacement: comparison of late survival between autografts and homografts Ann. Thorac. Surg., May 1, 2000; 69(5): 1327 - 1331. [Abstract] [Full Text] [PDF]
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C. Alexiou, A. McDonald, S. M. Langley, M. J. R. Dalrymple-Hay, M. P. Haw, and J. L. Monro Aortic valve replacement in children: are mechanical prostheses a good option? Eur J Cardiothorac Surg, February 1, 2000; 17(2): 125 - 133. [Abstract] [Full Text] [PDF]
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B. S. Marino, G. Wernovsky, J. Rychik, J. R. Bockoven, R. I. Godinez, and T. L. Spray Early Results of the Ross Procedure in Simple and Complex Left Heart Disease Circulation, November 9, 1999; 100(90002): II-162 - II-166. [Abstract] [Full Text] [PDF]
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S. K. Choudhary, A. Mathur, R. Sharma, A. Saxena, P. Chopra, R. Roy, and A. S. Kumar PULMONARY AUTOGRAFT: SHOULD IT BE USED IN YOUNG PATIENTS WITH RHEUMATIC DISEASE? J. Thorac. Cardiovasc. Surg., September 1, 1999; 118(3): 483 - 490. [Abstract] [Full Text] [PDF]
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H. K. Najm, J. G. Coles, M. D. Black, L. Benson, and W. G. Williams EXTENDED AORTIC ROOT REPLACEMENT WITH AORTIC ALLOGRAFTS OR PULMONARY AUTOGRAFTS IN CHILDREN J. Thorac. Cardiovasc. Surg., September 1, 1999; 118(3): 503 - 509. [Abstract] [Full Text] [PDF]
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F. M. Lupinetti, B. W. Duncan, A. M. Scifres, C. T. Fearneyhough, K. Kilian, G. L. Rosenthal, F. Cecchin, T. K. Jones, and S. P. Herndon Intermediate-term results in pediatric aortic valve replacement Ann. Thorac. Surg., August 1, 1999; 68(2): 521 - 525. [Abstract] [Full Text] [PDF]
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J.R. Bockoven, G. Wernovsky, V. L. Vetter, T. S. Wieand, T. L. Spray, and L. A. Rhodes Perioperative conduction and rhythm disturbances after the Ross procedure in young patients Ann. Thorac. Surg., October 1, 1998; 66(4): 1383 - 1388. [Abstract] [Full Text] [PDF]
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V. M. Reddy, D. B. McElhinney, C. K. Phoon, M. M. Brook, and F. L. Hanley Geometric mismatch of pulmonary and aortic anuli in children undergoing the Ross procedure: Implications for surgical management and autograft valve function J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1255 - 1263. [Abstract] [Full Text] [PDF]
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D. Mazzitelli, T. Guenther, C. Schreiber, M. Wottke, J. Michel, and H. Meisner Aortic valve replacement in children: are we on the right track? Eur J Cardiothorac Surg, May 1, 1998; 13(5): 565 - 571. [Abstract] [Full Text] [PDF]
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R. C. Elkins, C. J. Knott-Craig, K. E. Ward, and M. M. Lane The Ross Operation in Children: 10-Year Experience Ann. Thorac. Surg., February 1, 1998; 65(2): 496 - 502. [Abstract] [Full Text] [PDF]
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F. M. Lupinetti, J. Warner, T. K. Jones, and S. P. Herndon Comparison of Human Tissues and Mechanical Prostheses for Aortic Valve Replacement in Children Circulation, July 1, 1997; 96(1): 321 - 325. [Abstract] [Full Text]
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M. J. Tolan, P. E. Daubeney, Z. Slavik, B. R. Keeton, A. P. Salmon, and J. L. Monro Aortic Valve Repair of Congenital Stenosis With Bovine Pericardium Ann. Thorac. Surg., February 1, 1997; 63(2): 465 - 469. [Abstract] [Full Text]
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G. Sudow, L. Solymar, H. Berggren, B. Eriksson, D. Holmgren, and T. Gilljam AORTIC VALVE REPLACEMENT WITH A PULMONARY AUTOGRAFT IN INFANTS WITH CRITICAL AORTIC STENOSIS J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 433 - 436. [Abstract] [Full Text]
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V. Mohan Reddy, H. A. Rajasinghe, D. B. McElhinney, J. A. M. van Son, M. D. Black, N. H. Silverman, and F. L. Hanley Extending the limits of the Ross procedure Ann. Thorac. Surg., December 1, 1995; 60(suppl_3): S600 - S603. [Abstract] [PDF]
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A. Charles Yankah, H.-U. Wottge, and W. Muller-Ruchholtz Short-course cyclosporin a therapy for definite allograft valve survival immunosuppression in allograft valve operations Ann. Thorac. Surg., August 1, 1995; 60(suppl_2): S146 - S150. [Abstract] [PDF]
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Z. Al-Halees, N. Kumar, R. Gallo, B. Gometza, and C. M. G. Duran Pulmonary autograft for aortic valve replacement in rheumatic disease: A caveat Ann. Thorac. Surg., August 1, 1995; 60(suppl_2): S172 - S176. [Abstract] [PDF]
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P. C. Cartier, J. Metras, A. Cloutier, J. G. Dumesnil, G. Raymond, D. Doyle, D. Desaulniers, M. D. Lemieux, and S. Lentini Aortic valve replacement with pulmonary autograft in children and adults Ann. Thorac. Surg., August 1, 1995; 60(suppl_2): S177 - S179. [Abstract] [PDF]
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W. J. Daenen, M. A. Vanhove, and M. H. Gewillig Extended aortic root replacement with pulmonary autografts: Experience in 14 cases Ann. Thorac. Surg., August 1, 1995; 60(suppl_2): S180 - S184. [Abstract] [PDF]
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D. B. Ross, G. A. Trusler, J. G. Coles, I. M. Rebeyka, J. Smallhorn, W. G. Williams, and R. M. Freedom Small aortic root in childhood: Surgical options Ann. Thorac. Surg., December 1, 1994; 58(6): 1617 - 1624. [Abstract] [PDF]
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R. C. Elkins, C. J. Knott-Craig, K. E. Ward, C. McCue, and M. M. Lane Pulmonary autograft in children: Realized growth potential Ann. Thorac. Surg., June 1, 1994; 57(6): 1387 - 1394. [Abstract] [PDF]
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P. H. Schoof, A. H. Cromme-Dijkhuis, A. J. J. C. Bogers, E. J. M. Thijssen, M. Witsenburg, J. Hess, and E. Bos Aortic root replacement with pulmonary autograft in children J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 367 - 373. [Abstract] [Full Text]
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G. Gerosa, D. N. Ross, P. E. Brucke, A. Dziatkowiak, S. Mohammad, D. Norman, J. Davies, A. Sbarbati, and D. Casarotto Aortic valve replacement with pulmonary homograftsEarly experience J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 424 - 437. [Abstract] [Full Text]
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 D. M. Cohen Surgical Management of Congenital Heart Disease in the 1990s Arch Pediatr Adolesc Med, December 1, 1992; 146(12): 1447 - 1452. [Abstract] [PDF]
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R. McKay and D. N. Ross Commentary: Experience with pulmonary autografts for aortic stenosis Ann. Thorac. Surg., September 1, 1991; 52(3): 674 - 675. [PDF]
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