Analysis of 92 Mitral Pulmonary-Autograft Replacement (Ross II) Operations
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Objectives:
Because it is impractical for our patients to keep an anticoagulation regimen for life, we have tried to find an alternative to the mechanical prosthesis as a mitral substitute.
Methods:
Between July 14, 1997 and August 8, 2004 a total of 92 patients with irreparable mitral valve disease had their mitral valves replaced with the pulmonary autograft, encased within a Dacron tubing for support. In 4 patients the autograft had to be sacrificed at the initial operation. Of the remaining 88 patients 62 were female, and the age ranged between 4 and 64 years (mean 39). Eighty six patients were rheumatic and 2 congenital. Microwave energy has been used for ablation of concomitant atrial fibrillation since December 2002.
Results:
Operative transesophageal echocardiography revealed adequate valve characteristics (mean valve area 2.8 cm2; mean gradient 3.9 mmHg; no significant regurgitation) in all 88 patients. Operative mortality was 4 (4.6%), and late mortality related to the operation 7 (7.9%). Nine patients were lost to follow-up. Mean follow-up was 47 months. Three patients had their grafts explanted due to progressive regurgitation associated with stenosis developing over 2-5 years. Pathological evaluation of the explants revealed chronic inflammation, with evidence of rheumatic valvulitis in one. One more patient had her autograft explanted for endocriditis 3 years after operation. One patient developed a significant paravalvular leak that was repaired. Five more patients are being observed for progressive, but uncritical mitral stenosis. Four patients have developed uncritical pulmonic stenosis in their right ventricular outflow grafts. The rest of patients remain in mostly functional Class I status, with most (66%) in sinus rhythm, and most (63%) not on any form of anticoagulation.
Conclusions:
Although the Ross II operation is difficult and harbors significant risk, it remains an option for patients with irreparable mitral disease that cannot be placed on life anticoagulation.
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