Aortopulmonary size discrepancy is not a contraindication to the pediatric Ross operation
Identifieur interne : 000338 ( Istex/Corpus ); précédent : 000337; suivant : 000339Aortopulmonary size discrepancy is not a contraindication to the pediatric Ross operation
Auteurs : Frank A. Pigula ; Joseph Paolillo ; Michael Mcgrath ; Sanjiv K. Gandhi ; John L. Myers ; Beverly Rebovich ; Ralph D. SiewersSource :
- The Annals of Thoracic Surgery [ 0003-4975 ] ; 2001.
English descriptors
- KwdEn :
- 20, Annular, Annular anastomosis, Annular enlargement, Annular reduction, Annulus, Annulus body surface area ratio, Aortic, Aortic annular, Aortic annulus, Aortic valve replacement, Autograft, Autograft function, Congenital heart disease, Elkins, Pediatric, Pediatric patients, Pediatric ross operation, Pigula, Pulmonary autograft, Purse string reduction, Ross operation, Ross procedure, Surg, Surgical, Thorac, Thorac cardiovasc surg, Thorac surg, Thoracic surgeons.
- Teeft :
- Annular, Annular anastomosis, Annular enlargement, Annular reduction, Annulus, Annulus body surface area ratio, Aortic, Aortic annular, Aortic annulus, Aortic valve replacement, Autograft, Autograft function, Congenital heart disease, Elkins, Pediatric, Pediatric patients, Pediatric ross operation, Pigula, Pulmonary autograft, Purse string reduction, Ross operation, Ross procedure, Surg, Surgical, Thorac, Thorac cardiovasc surg, Thorac surg, Thoracic surgeons.
Abstract
Abstract: Background. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain.Methods. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography.Results. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m2 (p = 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m2 (p = 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m2 (p = 0.5).Conclusions. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.
Url:
DOI: 10.1016/S0003-4975(01)03078-8
Links to Exploration step
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<front><div type="abstract" xml:lang="en">Abstract: Background. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain.Methods. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography.Results. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m2 (p = 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m2 (p = 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m2 (p = 0.5).Conclusions. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.</div>
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<abstract>Abstract: Background. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain.Methods. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography.Results. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m2 (p = 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m2 (p = 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m2 (p = 0.5).Conclusions. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.</abstract>
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<notesStmt><note type="content">Section title: Original article: cardiovascular</note>
<note type="content">Fig 1: Annular reduction was accomplished in 8 patients with plication of the annulus with pledget, nonabsorbable sutures.</note>
<note type="content">Fig 2: Two patients with large aortopulmonary size discrepancies (≥ 6 mm diameter) were treated with purse string reduction of the aortic annulus, sized over a Heger dilator.</note>
<note type="content">Fig 3: One patient underwent excision of the posterior aortic annulus into the anterior leaflet of the mitral valve with reapproximation.</note>
<note type="content">Fig 4: Raw annular measurements obtained by serial echocardiography. Linear regression analysis shows little difference in the rate of annular enlargement, represented by the solid line, over time between the three groups (p > 0.05).</note>
<note type="content">Table 1: Mean Follow-up (Months) and Annulus/Body Surface Area Ratio at the Time of Insertion and Again at Follow-upa,b</note>
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<note type="biography">Address reprint requests to Dr Pigula, Pediatric Cardiothoracic Surgery, Room 2820, 2 Main, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213, USA</note>
<affiliation>Address reprint requests to Dr Pigula, Pediatric Cardiothoracic Surgery, Room 2820, 2 Main, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213, USA</affiliation>
<affiliation>Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA</affiliation>
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<abstract xml:lang="en"><p>Background. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain.Methods. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography.Results. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m2 (p = 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m2 (p = 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m2 (p = 0.5).Conclusions. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.</p>
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<head><ce:dochead><ce:textfn>Original article: cardiovascular</ce:textfn>
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<ce:title>Aortopulmonary size discrepancy is not a contraindication to the pediatric Ross operation</ce:title>
<ce:presented>Presented at the Thirty-seventh annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.</ce:presented>
<ce:author-group><ce:author><ce:given-name>Frank A</ce:given-name>
<ce:surname>Pigula</ce:surname>
<ce:degrees>MD</ce:degrees>
<ce:cross-ref refid="COR1"><ce:sup loc="post">*</ce:sup>
</ce:cross-ref>
<ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup>
</ce:cross-ref>
<ce:e-address type="email">pigulaf@heart.chp.edu</ce:e-address>
</ce:author>
<ce:author><ce:given-name>Joseph</ce:given-name>
<ce:surname>Paolillo</ce:surname>
<ce:degrees>MD</ce:degrees>
<ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup>
</ce:cross-ref>
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<ce:author><ce:given-name>Michael</ce:given-name>
<ce:surname>McGrath</ce:surname>
<ce:degrees>MD</ce:degrees>
<ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Sanjiv K</ce:given-name>
<ce:surname>Gandhi</ce:surname>
<ce:degrees>MD</ce:degrees>
<ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup>
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<ce:author><ce:given-name>John L</ce:given-name>
<ce:surname>Myers</ce:surname>
<ce:degrees>MD</ce:degrees>
<ce:cross-ref refid="AFF2"><ce:sup loc="post">b</ce:sup>
</ce:cross-ref>
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<ce:author><ce:given-name>Beverly</ce:given-name>
<ce:surname>Rebovich</ce:surname>
<ce:roles>PA</ce:roles>
<ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup>
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<ce:author><ce:given-name>Ralph D</ce:given-name>
<ce:surname>Siewers</ce:surname>
<ce:degrees>MD</ce:degrees>
<ce:cross-ref refid="AFF1"><ce:sup loc="post">a</ce:sup>
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<ce:affiliation id="AFF1"><ce:label>a</ce:label>
<ce:textfn>Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF2"><ce:label>b</ce:label>
<ce:textfn>Penn State Children’s Hospital, Hershey, Pennsylvania, USA</ce:textfn>
</ce:affiliation>
<ce:correspondence id="COR1"><ce:label>*</ce:label>
<ce:text>Address reprint requests to Dr Pigula, Pediatric Cardiothoracic Surgery, Room 2820, 2 Main, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213, USA</ce:text>
</ce:correspondence>
</ce:author-group>
<ce:abstract class="author"><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para view="all" id="simple-para.0040"><ce:italic>Background</ce:italic>
. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain.</ce:simple-para>
<ce:simple-para view="all" id="simple-para.0045"><ce:italic>Methods</ce:italic>
. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography.</ce:simple-para>
<ce:simple-para view="all" id="simple-para.0050"><ce:italic>Results</ce:italic>
. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m<ce:sup loc="post">2</ce:sup>
(<ce:italic>p</ce:italic>
= 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m<ce:sup loc="post">2</ce:sup>
(<ce:italic>p</ce:italic>
= 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m<ce:sup loc="post">2</ce:sup>
(<ce:italic>p</ce:italic>
= 0.5).</ce:simple-para>
<ce:simple-para view="all" id="simple-para.0055"><ce:italic>Conclusions</ce:italic>
. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
<ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title>
<ce:keyword><ce:text>20</ce:text>
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<abstract lang="en">Abstract: Background. Modification of the aortic annulus or the ascending aorta, or both, may be required in pediatric patients undergoing the Ross operation. The fate of these autografts remains uncertain.Methods. Retrospective review of 15 patients undergoing Ross operation without aortic annular modification (group 1), 11 patients requiring annular reduction (group 2, n = 11), and 8 patients requiring annular enlargement (group 3, n = 8). Autograft function and dimensions were evaluated by echocardiography.Results. Autograft insufficiency was less than or equal to mild in 33 patients and moderate in 1 patient. The annulus body surface area ratio increased in group 1 from 19.7 ± 5 to 20.3 ± 5 mm/m2 (p = 0.8). The average annular reduction in group 2 was 5 ± 1.5 mm, and 10 of 11 patients required reduction of the ascending aorta (mean 11 ± 5 mm). The annulus body surface area ratio increased from 18.6 ± 7 to 20.5 ± 9 mm/m2 (p = 0.2). The mean augmentation in annulus diameter in group 3 was 6 ± 4 mm; the annulus body surface area ratio decreased from 23.7 ± 14 to 20.3 ± 8 mm/m2 (p = 0.5).Conclusions. We continue to offer the Ross operation to pediatric patients even when aortic annular or ascending aortic size discrepancies mandate surgical modifications.</abstract>
<note type="content">Section title: Original article: cardiovascular</note>
<note type="content">Fig 1: Annular reduction was accomplished in 8 patients with plication of the annulus with pledget, nonabsorbable sutures.</note>
<note type="content">Fig 2: Two patients with large aortopulmonary size discrepancies (≥ 6 mm diameter) were treated with purse string reduction of the aortic annulus, sized over a Heger dilator.</note>
<note type="content">Fig 3: One patient underwent excision of the posterior aortic annulus into the anterior leaflet of the mitral valve with reapproximation.</note>
<note type="content">Fig 4: Raw annular measurements obtained by serial echocardiography. Linear regression analysis shows little difference in the rate of annular enlargement, represented by the solid line, over time between the three groups (p > 0.05).</note>
<note type="content">Table 1: Mean Follow-up (Months) and Annulus/Body Surface Area Ratio at the Time of Insertion and Again at Follow-upa,b</note>
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