Our Summary

This research paper discusses a 25-year study on the Ross procedure, a type of heart surgery. The Ross procedure involves replacing a patient’s faulty aortic valve with their own pulmonary valve. The main issue with this procedure is that the replacement valve can sometimes expand or ‘dilate’ over time.

The study involved 153 patients, almost a third of whom were children, who had the Ross procedure between 1991 and 2016. The survival rate was good - 85.4% of patients were still alive 20 years after the operation. In most patients, the replacement valve worked well and there were no instances of infection. However, around a quarter of the patients needed further surgery after an average of 11 years because their replacement valve had grown too big.

The good news is that in most of these reoperations, the surgeons were able to keep the replacement valve in place. They used two techniques, known as David and Yacoub, that aim to preserve the valve while fixing the problem. These reoperations had no early deaths, and only three patients needed to have their valve replaced with a man-made one within two years of their reoperation.

In conclusion, the study shows that while the Ross procedure can sometimes require further surgery, these reoperations are generally successful and the majority of patients can keep their original replacement valve.

FAQs

  1. What is the Ross procedure and what are the potential issues?
  2. What was the survival rate for patients who underwent the Ross procedure in the 25-year study?
  3. What are the David and Yacoub techniques used in reoperations of the Ross procedure?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pulmonary valve replacement is to be aware of the potential for the replacement valve to dilate over time. Regular follow-up appointments and monitoring of the valve’s size and function are important to catch any issues early on. If further surgery is needed, there are techniques available to preserve the original replacement valve and minimize the risk of complications. It’s also important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support overall heart health and the longevity of the replacement valve.

Suitable For

Patients who are typically recommended for pulmonary valve replacement include those with congenital heart defects, such as Tetralogy of Fallot or pulmonary atresia, who have a dysfunctional or leaky pulmonary valve. These patients may experience symptoms such as fatigue, shortness of breath, chest pain, and fainting episodes. Additionally, patients with pulmonary valve regurgitation, stenosis, or other abnormalities may also be candidates for pulmonary valve replacement.

In the case of the Ross procedure, patients who have a faulty aortic valve and a healthy pulmonary valve are often recommended for this surgery. This includes patients with aortic valve stenosis, regurgitation, or other defects that require valve replacement. The Ross procedure is particularly beneficial for younger patients, as it allows for better long-term durability and function of the replacement valve.

Overall, patients who are experiencing symptoms due to pulmonary valve dysfunction or other heart valve abnormalities may be recommended for pulmonary valve replacement. It is important for patients to consult with their healthcare provider to determine the most appropriate treatment plan based on their individual medical history and condition.

Timeline

Before pulmonary valve replacement:

  • Patient is diagnosed with a faulty pulmonary valve, which may cause symptoms such as shortness of breath, chest pain, and fatigue.
  • Patient undergoes various tests and evaluations to determine the best course of treatment.
  • Patient and healthcare team discuss the option of pulmonary valve replacement as a treatment option.
  • Surgery is scheduled and patient undergoes pre-operative preparations.

After pulmonary valve replacement:

  • Patient undergoes surgery to replace the faulty pulmonary valve with either a biological or mechanical valve.
  • Patient is monitored closely in the hospital for any complications or side effects.
  • Patient undergoes rehabilitation and physical therapy to aid in recovery.
  • Patient continues to have regular follow-up appointments with their healthcare team to monitor the function of the replacement valve and overall heart health.
  • In some cases, patient may require further surgery in the future if the replacement valve dilates or malfunctions.
  • Overall, patients can expect improved quality of life and symptom relief after pulmonary valve replacement.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pulmonary valve replacement include:

  1. What are the potential risks and complications associated with the Ross procedure?
  2. How long can I expect the replacement valve to last before potential dilation or other issues may arise?
  3. What symptoms should I watch out for that may indicate a problem with the replacement valve?
  4. How often will I need follow-up appointments and monitoring after the procedure?
  5. What are the success rates of reoperations to address any issues with the replacement valve?
  6. What are the differences between the David and Yacoub techniques for preserving the replacement valve during reoperations?
  7. Are there any lifestyle changes or restrictions I should be aware of after undergoing the Ross procedure?
  8. How experienced is the surgical team in performing the Ross procedure and handling any potential complications?
  9. Are there any alternative treatment options to consider besides the Ross procedure?
  10. What is the long-term prognosis for patients who have undergone a pulmonary valve replacement with the Ross procedure?

Reference

Authors: Ratschiller T, Eva SD, Schimetta W, Paulus P, Müller H, Zierer A, Mair R. Journal: J Thorac Cardiovasc Surg. 2018 Jun;155(6):2390-2397. doi: 10.1016/j.jtcvs.2018.01.095. Epub 2018 Feb 20. PMID: 29550073