Our Summary

This research paper is a review of a 25-year experience with a heart valve surgery known as the Ross procedure. The main issue with this procedure is that the new valve can expand over time, a problem known as autograft dilatation, which can lead to complications.

The study looked at the outcomes of 153 patients who underwent the Ross operation. They found that the survival rate was high, with 85.4% of patients still alive after 20 years. They also found that there was a low rate of complications, with no instances of infection in the new valve, and only 2.01% of patients experiencing deterioration of the valve each year. However, about 23% of patients needed another operation for an enlarged new valve an average of 11 years after the Ross procedure.

In most cases, the surgeons were able to perform a second operation that preserved the new valve, using techniques known as the David or Yacoub procedures. There was no early mortality associated with these reoperations, and the majority of patients still had their new valve intact at their latest check-up. The rate of patients free from needing a valve replacement was 92.1% at 15 years.

The authors concluded that the David or Yacoub techniques can effectively preserve the new valve in patients who develop an enlarged valve after the Ross procedure, with good outcomes and an acceptable rate of needing further interventions.

FAQs

  1. What is the main issue with the Ross heart valve surgery procedure?
  2. What were the key findings of the 25-year study on the Ross procedure?
  3. What are the David and Yacoub procedures mentioned in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about valve replacement, specifically the Ross procedure, is to be aware of the potential for the new valve to expand over time. Patients should follow up regularly with their healthcare provider to monitor the size of the new valve and address any issues that may arise. It is also important to be informed about the possibility of needing a second operation in the future to address valve enlargement, and to discuss the available options for preserving the new valve. Regular follow-up care and communication with healthcare providers are key to ensuring the long-term success of a valve replacement procedure.

Suitable For

Patients who are typically recommended valve replacement include those with severe symptoms of valve disease, such as chest pain, shortness of breath, fatigue, and dizziness. In addition, patients with severe valve regurgitation or stenosis, as well as those with valve disease that is causing heart failure or other complications, may also be recommended for valve replacement.

In the case of the Ross procedure, patients with aortic valve disease, particularly young patients, may be recommended for this surgery. The Ross procedure involves replacing the diseased aortic valve with the patient’s own pulmonary valve, and then replacing the pulmonary valve with a donor valve. It is often recommended for young patients because it has the potential to grow and adapt with the patient over time.

Overall, valve replacement may be recommended for patients with severe symptoms or complications of valve disease, as well as for those who are at risk for poor outcomes without intervention. The specific type of valve replacement procedure recommended will depend on the individual patient’s condition and medical history.

Timeline

Overall, a patient who undergoes a valve replacement procedure such as the Ross operation can expect to experience a high survival rate and low rate of complications in the years following the surgery. However, there is a risk of autograft dilatation, which may require further interventions such as a second operation to preserve the new valve. Patients may need to undergo additional procedures, such as the David or Yacoub techniques, to address complications related to autograft dilatation. With proper management and follow-up care, patients can have good long-term outcomes and maintain the function of their new valve.

What to Ask Your Doctor

Some questions a patient should ask their doctor about valve replacement, specifically the Ross procedure, include:

  1. What is the success rate of the Ross procedure in terms of survival and complications?
  2. What is the likelihood of my new valve expanding over time and needing further intervention?
  3. What are the signs and symptoms of an enlarged new valve that I should watch out for?
  4. How often will I need follow-up appointments to monitor the health of my new valve?
  5. What are the options for further interventions if my new valve does expand and require treatment?
  6. What is the expected lifespan of the new valve after the Ross procedure?
  7. Are there any lifestyle changes or medications I should consider to prolong the lifespan of the new valve?
  8. What are the potential risks and benefits of the David or Yacoub procedures for preserving the new valve in case of enlargement?
  9. How experienced is the surgical team in performing these reoperations if needed?
  10. Are there any alternative valve replacement options that may have lower rates of autograft dilatation?

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