Abstract
The Ross procedure has long been seen as an optimal operation for a select few. The detractors of it highlight the issue of an additional harvesting of the pulmonary artery, subjecting the native PA to systemic pressures and the need for reintervention as reasons to avoid it. However, the PA is a living tissue and capable of adapting and remodeling to growth. We therefore review the current evidence available to discuss the indications, contraindications, harvesting techniques, and modifications in a state-of-the-art narrative review of the PA as an aortic conduit. Due to the lack of substantial well-designed randomized controlled trials (RCTs), we also highlight the areas of need to reiterate the importance of the Ross procedure as part of the surgical armamentarium.
Highlights
From the results provided in the population of patients aged between 50 and 60 years, it is evident that the Ross procedure finds its optimal indication in people who, due to the absence of obvious comorbidities, are certainly more likely to benefit from the use of the pulmonary autograft
We have shown that the interaction between temporary bioresorbable reinforcement and pulmonary autograft has orchestrated a complex vascular remodeling process based on a balance between inflammation and production of extracellular matrix resulting after biomaterial resorption, in a “neovessel” which has characteristics similar to the aorta but is still biologically alive and capable of growing
The impact of the Ross procedure on long-term survival has been proven in young and middle-aged adults with significant impact when matching that of the age- and sexmatched general population, large propensity-matched observational studies and meta-analysis failed to cement its place as the ideal aortic valve substitute
Summary
The use of the pulmonary autograft (PA) as a substitute for aortic valve and root replacement (AVR/AVRR) was initially proposed by Donald Ross, and subsequently, it has been the subject of large observational studies and randomized controlled trials (RCTs) [1,2,3,4,5,6,7,8]. The current reluctance to use the PA may be related to the need for advanced planning for its use, which is necessarily dependent on obtaining the patient’s consent because potentially causing two pathologies with the intent of treating one [29,30,31] Another point of heated discussion concerns the necessity to adapt the positioning of the PA in relation to the young age of the patient that is a perceived as a concern for BioMed Research International the dilation of the neoaortic root and the consequent valve insufficiency leading for the dilation of the left ventricle. The recent publications of large series evaluating the outcomes for more than 20 years on the use of the PA, either for the subcoronary or miniroot strategy by Sievers et al and Nappi et al [11, 35, 36], justify a review of the current evidence supporting the use of the PA for AVD as a superior alternative to conventional valves in selected categories of patients, its indications and contraindications, as well as specific technical aspects that might impact results
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