Valve Sparing Root replacement after Ross procedure : a monocentric retrospective study

P0376 

Abstract Submission 

Pierre FLORES (1), OLIVIER BARON (2), Pierre Maminirina (3), Mohamedou LY (4)

(1) Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU de Rennes, Rennes, France, (2) N/A, Nantes Cedex, France, (3) N/A, Nantes, France, (4) Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, M3C, GHPSJ, Un, Le Plessis Robinson, FRANCE

Pierre FLORES    -  Contact Me
Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU de Rennes

OLIVIER BARON    -  Contact Me
N/A

Pierre Maminirina    -  Contact Me
N/A

Mohamedou LY    -  Contact Me
Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital, M3C, GHPSJ, Un

Pierre FLORES    -  Contact Me
N/A

Objective : More than 60 years after its first description, the Ross procedure has demonstrated its high durability and excellent long term results. However, due to the young age of the patients undergoing this procedure, reintervention after a Ross procedure is frequent.
In this study, we describe our experience in Redo surgery after a previous Ross procedure, focusing on valve-sparing root replacement (VSRR) and its durability.

Methods : We searched in our database all patients who were referred to a Redo surgery interessing the aortic root, after a previous Ross procedure, between January 2001 and November 2023. The indication could relate to the aortic or the pulmonary root. The attitude (changing the pulmonary homograft when surgery is performed for aortic dilatation and making a David procedure when surgery is indicated for pulmonary dehiscence) is supported by the natural history after a Ross procedure, meaning an aortic root dilatation (generating a left ventricular dysfunction) when the aortic root was not included during the first surgery, and a pulmonary dehiscence. The follow-up for all of them was provided by local cardiologists, including regular trans-thoracic echocardiography (TTE).

Results : From 1998 to 2023, 171 patients underwent a Ross procedure in our Hospital. Twenty-two of them needed a Redo surgery for aortic root dilatation or pulmonary root stenosis, with a planned gesture on the aortic root. Eleven underwent a mechanical valve implantation (Bentall procedure or Aortic Valve Replacement with Aortic tube), and 11 underwent a VSRR (David procedure).
In the population "VSRR procedure", four of them were indicated for surgery because of an aortic root dilatation with arctic valve regurgitation, six of them because of a pulmonary tube dehiscence with stenosis, and one of them for an infectious endocarditis on the pulmonary autograft. The mean age was 15,8 years (SD = 10,06 years). Mean follow up was 4,5 years. All of them underwent a David procedure associated with a changing of the pulmonary homograft.

The median aortic leak was ¾ when surgery was indicated for aortic dilatation and ¼ when surgery was indicated for pulmonary dehiscence.
Mean cross-clamp time was 173 minutes (SD = 31, 44) and mean cardiopulmonary bypass was 259 minutes (SD = 77,17).
The median ICU stay length was 4,5 days (IQR = 3,25 ; 7,25) and the median hospital stay length was 14 days (IQR = 7,5 ; 18,5).
Cumulative survival was 100% at hospital discharge, at 1 year, 2 years and 5 years.
Freedom from reoperation at hospital discharge was 90,9% (10/11), and equal at 1, 2 and 5 years.
No aortic valve regurgitation or aneurysmal dilatation of the aortic root was observed at hospital discharge or during the follow up, except for the one patient that underwent a new surgery (Mechanical Bentall procedure), after a diagnosis of infectious endocarditis on the aortic valve. One patient needed a catheterism for right coronary stenting because of a coronary compression.

Conclusion : David procedure seems to present good mid term-results when performed as a Redo after a Ross procedure. In our opinion, this should be performed for both aortic and pulmonary indication, to prevent a new short- or mid-term surgery for the patients, and especially before left ventricular dysfunction. This approach is, when feasible, supported by the youngness of this population.

Aortic Root