[HSF] AI and ASC AO Aneurysm s/p Ross procedure

[Ani Anyanwu]

Carmi
 
When you say the aortic root is dilated, i presume you mean the autograft is now aneurysmal or do you refer to the aorta above the autograft?
 
I did see a few of these reoperated when I was at Harefield for either failure of the autograft or pulmonary homograft but never both together. These were difficult reoperations as virtually every tissue plane around the two great vessels has been violated the first procedure. The autograft is living tissue so loses distinction from other tissues in the way dacron, xenograft or homograft would.
 
For a patient so young (44y), I think the best strategy would be to send the patient back to the original surgeon, or to any other surgeon with extensive Ross experience as they also have experience in dealing with the reoperations. For a patient who does not want a mechanical valve there are other options, for example I think Hannover reported their Ross reoperations and a number of those presenting with autograft dilatation are now treated with a David procedure retaining the original autograft valve and hence (at least theoretically) maintaining longevity of the valve. For the pulmonary homograft, provided there is no stenosis of the conduit we replaced this with a stented valve and a small patch enlargement.
 
Ani
 



> From: Cysmd613 at aol.com> Date: Thu, 6 Sep 2007 01:00:52 -0400> To: OpenHeart-L at lists.hsforum.com> CC: > Subject: [HSF] AI and ASC AO Aneurysm s/p Ross procedure> > I would like to get the Forum's opinions and advice concerning an interesting > patient referred to me.> > 44 yo male who underwent Ross Procedure in 1995 (pulmonary homograft used to > replace PV and prox PA) for a 6cm ascending aortic aneurysm and bicuspid > aortic valve. According to the op report, he did not have AI pre op. > Recently he has been having some dyspnea on exertion and decreased stamina > (he used to surf for 4 to 5 hours a day, now he can only last about 1.5 hours). > An echo showed moderate to severe AI, a 5.5 cm aortic root, and a significant > gradient across the pulmonic valve.> Appears that he needs redo aortic root replacement and pulmonic valve > replacement.> In your experience, how difficult is the dissection after a Ross procedure, > as I haven't had the pleasure of operating on a patient who has had a prior > Ross. > This patient does not wish a mechanical valve, so I would plan to use > pericardial valves.> > Thank you in advance for your responses.> > Carmi Stadlan> > > > ************************************** Get a sneak peek of the all-new AOL at > http://discover.aol.com/memed/aolcom30tour> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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