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J Thorac Cardiovasc Surg 2007;134:902-908
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Analysis of 92 mitral pulmonary autograft replacement (Ross II) operations

Sami Kabbani, MD*, Hisham Jamil, MD, Fawzi Nabhani, MD, Abdo Hamoud, MD, Karam Katan, MD, Nada Sabbagh, MD, Abir Koudsi, PhD, MD, Loay Kabbani, MD, Ghiath Hamed, MD

Damascus University Cardiovascular Surgical Center, Mezza, Damascus, Syria.

Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.

Received for publication May 29, 2006; revisions received April 29, 2007; accepted for publication May 11, 2007.

* Address for reprints: Sami Kabbani, MD, Damascus University Cardiovascular Surgical Center, Mezza Str, PO Box 2837, Damascus, Syria. (Email: dam-uncv{at}net.sy).

Objective: The study objective was to find a mitral valve substitute that does not require lifelong anticoagulation and is not affected by tissue degeneration in the long term.

Methods: Between July 14, 1997, and August 8, 2004, a total of 92 patients with irreparable mitral valve disease underwent mitral valve replacement with the pulmonary autograft encased within a Dacron tubing for support. In 4 patients, the autograft had to be sacrificed at the initial operation. Of the remaining 88 patients, 62 were female, and the age ranged from 4 to 64 years (mean 39 years). Eighty-six patients had rheumatic mitral disease, and 2 patients had congenital mitral disease.

Results: Operative transesophageal echocardiography initially showed adequate valve characteristics (mean valve area 2.8 cm2, mean gradient 3.9 mm Hg, no significant regurgitation) in all 88 patients. Operative mortality was 4.6%, and late mortality definitely related to the operation was 7.9%. Four patients were lost to follow-up; the mean follow-up was 60 months. Progressive regurgitation and stenosis developed in 9 patients over 2 to 5 years, 4 of whom had their grafts explanted. The autograft was explanted in 1 patient because of endocarditis. Mild pulmonic stenosis developed in 3 patients, and critical pulmonic stenosis developed in 1 patient. At 5 years follow-up, freedom from degeneration was 93.4%, freedom from reoperation was 94.2%, and freedom from all death was 86.0%.

Conclusion: Although the Ross II operation is difficult and harbors significant risk, it remains an option for patients with irreparable mitral disease who have a long life expectancy and who cannot be placed on lifelong anticoagulation.

Abbreviation and Acronym TEE = transesophageal echocardiography


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J. Thorac. Cardiovasc. Surg. 2007 134: 907-908. [Extract] [Full Text] [PDF]



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