Key result
Autologous inclusion technique is associated with lower aortic valve gradients than Dacron and 0% mortality.
Why the study?
Pulmonary autografts in the Ross procedure remain at risk of late dilation, but the autologous inclusion technique and Dacron inclusion technique have not been directly compared.
Does the autologous inclusion technique compared to the Dacron inclusion technique improve postoperative gradients and clinical outcomes in adults undergoing modified Ross surgery?
Observational (n=43)
No
Does the autologous inclusion technique compared to the Dacron inclusion technique improve postoperative gradients and clinical outcomes in adults undergoing modified Ross surgery?
Absolute Event Rate: 0% vs 0%
Both autologous and Dacron inclusion techniques in modified Ross surgery provide excellent mid-term survival and freedom from reoperation, though the autologous technique results in slightly lower postoperative aortic valve gradients.
Both inclusion techniques yield excellent mid-term Ross outcomes; extends single-center data but leaves open randomized confirmation of durability.
The Ross procedure has been shown to have excellent long-term outcomes. However, pulmonary autografts remain at risk of dilation in the long-term period. Therefore, the autologous inclusion technique (AIT) and the Dacron inclusion technique (DIT) have been developed. No direct comparison up to date has been reported of these two techniques. Aim: To compare immediate and medium-term results performing various modified techniques of the Ross operation. Material and Methods. The following retrospective study included 43 patients (AIT: 22; DIT: 21) aged 18 years and older with an aortic valve (AV) pathology who underwent modified Ross procedures (AIT and DIT) from January 2014 to December 2019, performed by a single surgeon. The main endpoints were: in-hospital mortality, postoperative AV pressure gradients, time of myocardial ischemia and cardiopulmonary bypass, postoperative complications (resternotomy due to bleeding, perioperative myocardial infarction, stroke, sternal infection, conduction disorder requiring implantation of a permanent pacemaker, acute renal failure requiring hemodialysis) and mid-term outcomes (freedom from reoperation, freedom from aortic dilatation ≥ 5 cm). The median follow-up period was 23 (12–68) months. Results. The main indication for surgery was aortic regurgitation in 32 patients (74.4%). Bicuspid aortic valve was diagnosed in 29 (67.4%) patients. There were 33 (76.7%) males with an average age of 40 ± 11.7 years. There were no lethal outcomes in both groups. There was also no significant difference in postoperative complications. The peak and mean gradients on the AV were significantly lower in the AIT group than in the DIT group (6 and 4 mmHg vs 8 and 7 mmHg, p = 0.04). Five-year overall survival, freedom from reoperation on AV and PV, and freedom from dilatation of the ascending aorta ≥ 5 cm after modified Ross operation were 97.4%, 100%, and 100%, respectively. There was no statistically significant difference between groups in terms of overall survival (p = 0.66). Conclusion. Both techniques, autologous inclusion and Dacron inclusion, provide excellent immediate and mid-term outcomes in terms of overall survival, freedom from reoperation and freedom from aortic dilation
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Чернов et al. (2024) conducted an observational in aortic valve pathology (n=43). Autologous inclusion technique (AIT) vs. Dacron inclusion technique (DIT) was evaluated on in-hospital mortality. The autologous inclusion technique yielded 0% in-hospital mortality and significantly lower mean aortic valve gradients than the Dacron technique (4 vs 7 mmHg, p=0.04).
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