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J Thorac Cardiovasc Surg 2007;134:902-908
© 2007 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
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.
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J. Thorac. Cardiovasc. Surg. 2007 134: 907-908.
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