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• W3093555837 abstract "In this issue of The Annals of Thoracic Surgery, Bové and colleagues1Bové T. Bradt N. Martens T. et al.The pulmonary autograft after the Ross operation: results of 25-year follow-up in a pediatric cohort.Ann Thorac Surg. 2021; 111: 159-168Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar from Belgium report long-term follow-up for a series of 137 children with congenital aortic valve disease who underwent a Ross-only or Ross-Konno operation using a root replacement technique. This study offers a rare look at serial autograft dimensions over 2 decades. One valuable aspect is the authors’ description of the evolution of autograft diameters and Z scores at the level of the annulus, sinus, and sinotubular junction. They observed that the sinus and sinotubular junction dilated at a faster rate compared with the annulus. Importantly, although the annual growth rate of the sinus and sinotubular junction was low, it was sustained over 2 decades. Also, the authors found that, in general, the Ross-only patients had a larger diameter autograft at each of the 3 levels but that the rate of dilation at each level (by Z score) was significantly faster in the Ross-Konno group. I appreciated that the authors analyzed Ross-Konno patients (n = 27, 20%) and Ross-only patients separately, as these patient groups are quite different when considering initial valve choice. In general, valve options for Ross-Konno patients are profoundly limited. Not surprisingly, on the one hand, Ross-Konno patients in this study were younger at operation (0.5 years vs 10 years; P < .001; 52% infants), had more complex heart disease, and suffered higher early mortality (33% vs 6%; P < .001). On the other hand, 77% of the Ross-only patients had isolated aortic valve disease (most commonly stenosis) and a much wider range of valve options at the time of aortic valve replacement. As aortic valve replacement options increase, this study presents detailed information that adds to our knowledge of the behavior of the pulmonary autograft over time, and it is helpful when counseling patients preoperatively, particularly older children, adolescents, and teens anticipating an isolated Ross operation. From a surgeon’s viewpoint, Bové and colleagues1Bové T. Bradt N. Martens T. et al.The pulmonary autograft after the Ross operation: results of 25-year follow-up in a pediatric cohort.Ann Thorac Surg. 2021; 111: 159-168Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar present excellent clinical results, and the rate of autograft dilation they describe is optimistic, compared with other large series.2Mokhles M.M. Rizopoulos D. Andrinopoulou E.R. et al.Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study.Eur Heart J. 2012; 33: 2213-2224Crossref PubMed Scopus (55) Google Scholar However, predicted need for reoperation is arguably at the top of the valve decision-making algorithm for patients. Despite the fact that Ross-only patients in the Bové study enjoyed excellent 20-year survival and greater than 97% retained their native autograft valve, patients and families may be more profoundly influenced by the realization that reoperations were still common in the second decade after surgery. In fact, Varrica and colleagues3Varrica A. Caldaroni F. Saitto G. et al.Outcomes and quality of life after ross reintervention: would you make the same choice again?.Ann Thorac Surg. 2020; 110: 214-220Abstract Full Text Full Text PDF Scopus (2) Google Scholar reported in the July 2020 issue of The Annals that among patients eligible for a mechanical valve vs a Ross procedure, most Ross patients who had a reoperation would not make the same valve choice again. In light of the Varrica and colleagues3Varrica A. Caldaroni F. Saitto G. et al.Outcomes and quality of life after ross reintervention: would you make the same choice again?.Ann Thorac Surg. 2020; 110: 214-220Abstract Full Text Full Text PDF Scopus (2) Google Scholar report, it must be recognized that patients do necessarily perceive lack of anticoagulation as an acceptable trade-off compared with a reoperation. In other words, the need for reoperation may be associated with worse quality of life, compared with committing to lifelong daily anticoagulation and its associated risks. While surgical reinforcement techniques may limit autograft dilation in eligible patients, right ventricular outflow tract reoperations were still performed in greater than 25% of Ross-only patients in this series by 20 years. Bové and colleagues provide new, detailed information to help physicians, patients, and parents make informed decisions about valve choice. It is the surgeon’s responsibility to thoroughly explain the risks of reoperation compared with other viable valve options. The Pulmonary Autograft After the Ross Operation: Results of 25-Year Follow-Up in a Pediatric CohortThe Annals of Thoracic SurgeryVol. 111Issue 1PreviewProgressive autograft dilation and need for later reoperation remain major concerns of the Ross procedure. The study investigates the clinical outcome after the Ross operation, including a longitudinal analysis of autograft dimensions over 25 years. Full-Text PDF" @default.
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• W3093555837 date "2021-01-01" @default.
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• W3093555837 title "Good News or Bad News? Considering Physician and Patient Perspectives on Outcomes" @default.
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• W3093555837 doi "https://doi.org/10.1016/j.athoracsur.2020.07.084" @default.
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