HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Choudhary, S. K. Articles by Kumar, A. S. Search for Related Content PubMed PubMed Citation Articles by Choudhary, S. K. Articles by Kumar, A. S.

J Thorac Cardiovasc Surg 1999;118:483-490
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

PULMONARY AUTOGRAFT: SHOULD IT BE USED IN YOUNG PATIENTS WITH RHEUMATIC DISEASE?

From the Department of Cardiothoracic and Vascular Surgery,^a Department of Cardiology,^b and the Department of Pathology,^c All India Institute of Medical Sciences, New Delhi, India.

Address for reprints: A. Sampath Kumar, Professor, Department of Cardiothoracic and Vascular Surgery, All India Insitute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.

Background: Although pulmonary autograft is being increasingly used to replace the diseased aortic valve with excellent long-term results, its use in the population with rheumatiic disease still needs careful evaluation.
Patients and methods: From October 1993 through March 1998, 102 patients underwent aortic valve replacement with a pulmonary autograft (Ross procedure). The mean age was 27.9 ± 4.2 years (range, 0.8-56 years). The cause was rheumatic disease in 75 patients (73%), bicuspid aortic valve in 26 patients (26%), and myxomatous aortoarteritis in 1 patient (1%). The root replacement technique was used in all. In addition, 31 patients had 33 associated procedures: mitral valve repair (n = 15 patients), open mitral commissurotomy (n = 15 patients), tricuspid repair (n = 2 patients), and homograft mitral valve replacement (n = 1 patient).
Results: Operative mortality was 6.9% (7 patients). Late mortality was 7.8% (8 patients). Follow-up ranged from 1 to 60 months (mean, 25.3 ± 15.4 months) and was 98% complete. Two patients required reoperation for failed mitral valve repair, and 2 other patients underwent reoperation for failure of both the autograft and mitral valve repair. Echocardiographic assessment showed moderate to severe aortic regurgitation in 13 patients, along with thickening of the autograft. All of these patients had rheumatic disease and were young (<30 years). Ten of these patients had undergone associated mitral valve procedure. Morphologic and histopathologic examination of explanted autografts showed features compatible with rheumatic valvulitis.
Conclusion: Pulmonary autograft is susceptible to rheumatic involvement. Young age (<30 years) and associated mitral valve disease are significant risk factors for autograft failure in patients with rheumatic disease. Use of pulmonary autograft in this subgroup of patients requires a cautious approach.

This article has been cited by other articles:

				A. Sampath Kumar, S. Talwar, A. Saxena, and R. Singh Ross procedure in rheumatic aortic valve disease Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 156 - 161. [Abstract] [Full Text] [PDF]

				S. Talwar, R. Mohapatra, A. Saxena, R. Singh, and A. S. Kumar Aortic Homograft: A Suitable Substitute for Aortic Valve Replacement Ann. Thorac. Surg., September 1, 2005; 80(3): 832 - 838. [Abstract] [Full Text] [PDF]

				A. S. Kumar, S. Talwar, R. Mohapatra, A. Saxena, and R. Singh Aortic Valve Replacement With the Pulmonary Autograft: Mid-Term Results Ann. Thorac. Surg., August 1, 2005; 80(2): 488 - 494. [Abstract] [Full Text] [PDF]

				S. Talwar, C. Saikrishna, A. Saxena, and A. Sampath Kumar Aortic Valve Repair for Rheumatic Aortic Valve Disease Ann. Thorac. Surg., June 1, 2005; 79(6): 1921 - 1925. [Abstract] [Full Text] [PDF]

				N. D. Hillman, L. Y. Tani, L. G. Veasy, L. L. Lambert, G. B. Di Russo, D. B. Doty, E. C. McGough, and J. A. Hawkins Current Status of Surgery for Rheumatic Carditis in Children Ann. Thorac. Surg., October 1, 2004; 78(4): 1403 - 1408. [Abstract] [Full Text] [PDF]

				H. H. Sievers, G. Dahmen, B. Graf, U. Stierle, A. Ziegler, and C. Schmidtke Midterm Results of the Ross Procedure Preserving the Patient's Aortic Root Circulation, September 9, 2003; 108(90101): II-55 - 60. [Abstract] [Full Text] [PDF]

				J.-M. Grinda, C. Latremouille, A. J. Berrebi, R. Zegdi, S. Chauvaud, A. F. Carpentier, J.-N. Fabiani, and A. Deloche Aortic cusp extension valvuloplasty for rheumatic aortic valve disease: midterm results Ann. Thorac. Surg., August 1, 2002; 74(2): 438 - 443. [Abstract] [Full Text] [PDF]

				J.-M. Grinda, C. Latremouille, N. D'Attellis, A. Berrebi, S. Chauvaud, A. Carpentier, J.-N. Fabiani, and A. Deloche Triple valve repair for young rheumatic patients Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 447 - 452. [Abstract] [Full Text] [PDF]

				Ross Procedure Inappropriate for Younger Patients with Rheumatic Heart Disease Journal Watch Cardiology, October 14, 1999; 1999(1014): 1 - 1. [Full Text]