Externally Supported Ross Procedures Demonstrate ‘Excellent’ Results
Published Fall 2020 | Seminars in Thoracic and Cardiovascular Surgery
When children are born with aortic valve defects, many receive a Ross procedure (usually in their teen years) to repair this potentially life-threatening condition. Dating back to 1967, this procedure involves using a child’s own pulmonary valve to replace their damaged aortic valve, then replacing the pulmonary valve with donor tissue.
For children and young adults, this procedure remains the ideal option for aortic valve replacement because it provides better blood flow, poses fewer infection risks, and avoids blood clotting that can occur with mechanical and prosthetic valves. However, the procedure has long come with concerns that the relocated pulmonary valve might be too weak to withstand the pressures that the aortic valve experiences.
James Tweddell, MD, director of Cardiothoracic Surgery at Cincinnati Children’s Heart Institute, is widely credited with developing an external support technique that improves the success of the procedure. The technique involves grafting a Dacron tube around the replacement valve for enhanced support. Now, a “mid-term” study led by first author Kyle Riggs, MD, evaluates outcomes for 40 patients treated from 2005 to 2018 with Tweddell’s technique.
“We have shown that, at intermediate follow-up, patients who underwent a supported Ross technique were less likely to have neoaortic root dilatation. At last follow-up, 39 patients had mild or less aortic regurgitation with median sinus z-score of 1.40,” Tweddell says.
Median follow-up lasted 3.5 years, with three patients followed for more than a decade. All of the patients had survived. While five patients needed a reintervention, only one involved the aortic valve.
Ross Procedure
This illustration depicts the basic steps of the Ross Procedure to correct for aortic valve defects. (Source: Bruce Blaus Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1)
