Analysis of 92 mitral pulmonary autograft replacement (Ross II) operations Sami Kabbani, MD, Hisham Jamil, MD, Fawzi Nabhani, MD, Abdo Hamoud, MD, Karam.

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Presentation transcript:

Analysis of 92 mitral pulmonary autograft replacement (Ross II) operations Sami Kabbani, MD, Hisham Jamil, MD, Fawzi Nabhani, MD, Abdo Hamoud, MD, Karam Katan, MD, Nada Sabbagh, MD, Abir Koudsi, PhD, MD, Loay Kabbani, MD, Ghiath Hamed, MD The Journal of Thoracic and Cardiovascular Surgery Volume 134, Issue 4, Pages 902-908.e7 (October 2007) DOI: 10.1016/j.jtcvs.2007.05.056 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Actuarial freedom from valve degeneration in “successful” Ross II procedures. N = number of patients included in the analysis at the beginning of each year follow-up. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Actuarial freedom from reoperation in “successful” Ross II procedures. N = number of patients included in the analysis at the beginning of each year follow-up. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Actuarial survival curve in “successful” Ross II procedures. N = number of patients included in the analysis at the beginning of each year follow-up. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Distribution of patients according to 10-year age groups; the total number of patients and percentages in each age group are presented. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Stages of operation. A, Flap of pericardium 10 cm long is created and left hanging until a decision is made to perform operation. B, If mitral reconstruction is impossible and a Ross II operation is decided on, a 10 × 4 cm of pericardium (in the adult patient) is excised. C, Pulmonary autograft is taken down as in the classic Ross operation. D, Pulmonary substitute (preferably a pulmonary homograft) is interposed. E, A 2.5-cm piece from a crimped woven (preferably rigid) Dacron tubing (usually 30 mm in diameter) is cut off and marked at both ends with 6 equidistant points, starting with the prefabricated line. F, Pericardial strip is wrapped around the Dacron tubing (smooth surface out), and an adhesive glue is applied to its inner surface. G, Excess pericardium is cut off to adjust the length and height of the pericardial strip to the Dacron tubing. H, Autograft is cleaned of fatty tissue and trimmed down to 2 mm beyond the commissures distally and down to 2 mm of ventricular muscle proximally. I, Prepared autograft is inserted within the Dacron tubing, and its distal (pulmonary) end is anchored to the Dacron pericardial tube with 3 temporary 4-0 polypropylene sutures. J, Similar procedure is done with the proximal (ventricular) end of the autograft. K, A 5-0 polytetrafluorethylene running stitch is applied distally joining the autograft and Dacron/pericardial conduit, removing stay sutures as they are reached. L, Distal running suture is complete. A similar procedure is carried out proximally, in effect completing the preparation of the conduit and covering all Dacron material. M, Distal end of the prepared conduit is sutured to the annulus of the excised mitral valve after preserving the subvalvular apparatus as much as possible, applying some form of atrial fibrillation ablation if necessary, and excluding the left atrial appendage. N, Schematic profile of the operation. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Stages of operation. A, Flap of pericardium 10 cm long is created and left hanging until a decision is made to perform operation. B, If mitral reconstruction is impossible and a Ross II operation is decided on, a 10 × 4 cm of pericardium (in the adult patient) is excised. C, Pulmonary autograft is taken down as in the classic Ross operation. D, Pulmonary substitute (preferably a pulmonary homograft) is interposed. E, A 2.5-cm piece from a crimped woven (preferably rigid) Dacron tubing (usually 30 mm in diameter) is cut off and marked at both ends with 6 equidistant points, starting with the prefabricated line. F, Pericardial strip is wrapped around the Dacron tubing (smooth surface out), and an adhesive glue is applied to its inner surface. G, Excess pericardium is cut off to adjust the length and height of the pericardial strip to the Dacron tubing. H, Autograft is cleaned of fatty tissue and trimmed down to 2 mm beyond the commissures distally and down to 2 mm of ventricular muscle proximally. I, Prepared autograft is inserted within the Dacron tubing, and its distal (pulmonary) end is anchored to the Dacron pericardial tube with 3 temporary 4-0 polypropylene sutures. J, Similar procedure is done with the proximal (ventricular) end of the autograft. K, A 5-0 polytetrafluorethylene running stitch is applied distally joining the autograft and Dacron/pericardial conduit, removing stay sutures as they are reached. L, Distal running suture is complete. A similar procedure is carried out proximally, in effect completing the preparation of the conduit and covering all Dacron material. M, Distal end of the prepared conduit is sutured to the annulus of the excised mitral valve after preserving the subvalvular apparatus as much as possible, applying some form of atrial fibrillation ablation if necessary, and excluding the left atrial appendage. N, Schematic profile of the operation. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Stages of operation. A, Flap of pericardium 10 cm long is created and left hanging until a decision is made to perform operation. B, If mitral reconstruction is impossible and a Ross II operation is decided on, a 10 × 4 cm of pericardium (in the adult patient) is excised. C, Pulmonary autograft is taken down as in the classic Ross operation. D, Pulmonary substitute (preferably a pulmonary homograft) is interposed. E, A 2.5-cm piece from a crimped woven (preferably rigid) Dacron tubing (usually 30 mm in diameter) is cut off and marked at both ends with 6 equidistant points, starting with the prefabricated line. F, Pericardial strip is wrapped around the Dacron tubing (smooth surface out), and an adhesive glue is applied to its inner surface. G, Excess pericardium is cut off to adjust the length and height of the pericardial strip to the Dacron tubing. H, Autograft is cleaned of fatty tissue and trimmed down to 2 mm beyond the commissures distally and down to 2 mm of ventricular muscle proximally. I, Prepared autograft is inserted within the Dacron tubing, and its distal (pulmonary) end is anchored to the Dacron pericardial tube with 3 temporary 4-0 polypropylene sutures. J, Similar procedure is done with the proximal (ventricular) end of the autograft. K, A 5-0 polytetrafluorethylene running stitch is applied distally joining the autograft and Dacron/pericardial conduit, removing stay sutures as they are reached. L, Distal running suture is complete. A similar procedure is carried out proximally, in effect completing the preparation of the conduit and covering all Dacron material. M, Distal end of the prepared conduit is sutured to the annulus of the excised mitral valve after preserving the subvalvular apparatus as much as possible, applying some form of atrial fibrillation ablation if necessary, and excluding the left atrial appendage. N, Schematic profile of the operation. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Stages of operation. A, Flap of pericardium 10 cm long is created and left hanging until a decision is made to perform operation. B, If mitral reconstruction is impossible and a Ross II operation is decided on, a 10 × 4 cm of pericardium (in the adult patient) is excised. C, Pulmonary autograft is taken down as in the classic Ross operation. D, Pulmonary substitute (preferably a pulmonary homograft) is interposed. E, A 2.5-cm piece from a crimped woven (preferably rigid) Dacron tubing (usually 30 mm in diameter) is cut off and marked at both ends with 6 equidistant points, starting with the prefabricated line. F, Pericardial strip is wrapped around the Dacron tubing (smooth surface out), and an adhesive glue is applied to its inner surface. G, Excess pericardium is cut off to adjust the length and height of the pericardial strip to the Dacron tubing. H, Autograft is cleaned of fatty tissue and trimmed down to 2 mm beyond the commissures distally and down to 2 mm of ventricular muscle proximally. I, Prepared autograft is inserted within the Dacron tubing, and its distal (pulmonary) end is anchored to the Dacron pericardial tube with 3 temporary 4-0 polypropylene sutures. J, Similar procedure is done with the proximal (ventricular) end of the autograft. K, A 5-0 polytetrafluorethylene running stitch is applied distally joining the autograft and Dacron/pericardial conduit, removing stay sutures as they are reached. L, Distal running suture is complete. A similar procedure is carried out proximally, in effect completing the preparation of the conduit and covering all Dacron material. M, Distal end of the prepared conduit is sutured to the annulus of the excised mitral valve after preserving the subvalvular apparatus as much as possible, applying some form of atrial fibrillation ablation if necessary, and excluding the left atrial appendage. N, Schematic profile of the operation. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 A, Postoperative 4-chamber view echocardiogram of the autograft/Dacron conduit. B, Two-dimensional echocardiogram with color Doppler during systole and diastole. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Comparative actuarial curves for freedom from reoperation. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Comparative actuarial survival curves. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 902-908.e7DOI: (10.1016/j.jtcvs.2007.05.056) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions