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J Thorac Cardiovasc Surg 2003;126:245-246
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Discussion

Dr John A. Hawkins (Salt Lake City, Utah). Mark, first I commend you and your colleagues on excellent results obtained in this very difficult group of patients. Basically Dr Lupinetti and Dr Duncan and their colleagues have reported a large series of children undergoing AVR with both autografts and allografts, with only a 3% operative mortality and a single late death and an acceptable level of late morbidity. These are really admirable numbers for a complex group of patients dating from what I would assume is your first Ross procedure in 1994. From the outset I will have to say I am really a true believer in the Ross procedure and have no arguments with your approach. I would summarize your message this morning as basically, do a Ross procedure when you can and an allograft when you cannot. The significant findings you showed us today were that the left ventricular outflow tract Vmax basically increased in allografts and significantly decreased in the autograft group, while left ventricular posterior wall thickness decreased significantly in the autograft group and remained unchanged in the allograft group.

My first question has to do with the finding in your series of this significant increase in the Doppler-measured Vmax across the left ventricular outflow tract. What was the follow-up in both groups of patients? You stated that the follow-up was simply 1 to 80 months. What is the problem with the allografts developing this late gradient? Is it simply a time-related or growth phenomenon rather than a problem with the allograft . . . [Full Text of this Article]

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Flavian M. Lupinetti, Brian W. Duncan, Mark Lewin, Umesh Dyamenahalli, and Geoffrey L. Rosenthal
J. Thorac. Cardiovasc. Surg. 2003 126: 240-245. [Abstract] [Full Text] [PDF]