ABSTRACT 42

PULMONARY AUTOGRAFT (THE ROSS) OPERATION AND "PERICARDIAL COLLAR" TECHNIQUE FOR THE RIGHT VENTRICUALR OUTFLOW TRACT RECONSTRUCTION

T. Sarioglu, E.Erek, B. Kinoglu, E.Salihoglu, A. Sarioglu, N.Soybir
Istanbul Memorial Medical Center
Istanbul University: Institute of Cardiology

Objectives:  Technical demands of the Ross operation and two valves at risk have delayed acceptance.  Its increasing popularity in 90’s was due to excellent long-term results, no need for anticoagulation and its growing capacity.  The results of 18 consecutive patients who underwent Ross procedure and a new pericardial collar technique during the reconstruction of right ventricular outflow (RVOT) was documented in this article.

Methods:  Patients ages ranged from 9 to 37 years (mean 16,2 ± 7,1 years). Three of them had prior open heart operation.  Total root replacement technique was used in all patients.  Aortoplasty were done in tow patients with aortic root dilatation. Ross/Konno procedure was performed in three patients with bioprosthesis in 12 patients for RVOT reconstructions.  A new "pericardial collar technique” is used as a part of RVOT reconstruction to avoid damage to the first septal artery during implantation and to prevent persistent bleeding from septal dissection area. A strip of pericardiaum (1 x 4 cm) is sutured to the epicardial edge of the posterior and septal part of thre RVOT.  Them conduit is sutured to the pericardial strip at the posterior part of the anstomosis.  At the anterior and lateral part of the anstomosis, conduit is sutured to the right ventricular muscle directly.  Additional mitral plasty was performed in one patient but mitral vale replacement was performed subsequently because of persistent mitral regurgiationon transesophagal echocardiography.

Results:  One patient who operated urgently because of acute hemodynamic deterioriation and active bacterial endocarditis died in early postoperative periord.  Right ventricular dysfunction and complete atrioventricular block was seen in a patient.  Right ventricular dysfunction and complete atrioventricular block was seen in a patient Right mammary to right coronary artery bypass and permanent pacemaker implantation one month later was performed.  One patient who undergone Ross and MVR was reoperated owing to endocarditis.  Other patients had uneventful postoperative course.  Follow-up ranged from 1 to 32 months (mean 15,2 ± 9 months) for all patients.  Echocardiographic examinations during follow-up period showed normal aortic valve or trivial aortic regurgitation in all but one patient, who had moderate aortic regurgitation.

Conclusions:  We can say that, Ross operation could be the alternative procedure for the prosthetic aortic valve replacement in selected patients (child, young adults and ladies) and we think that, pericardial collar techniqe is a useful modification for Ross procedure.  It offers a safe and strong margin for  anastomosis of the RVOT conduit posteriorly.  It also prevents persistent bleeding from septal dissection area by including the bleeding area into the right ventricular cavity instead of pericardial space.