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Hans-H. Sievers, MD, Ulrich Stierle, MD, Efstratios I

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Presentation on theme: "Hans-H. Sievers, MD, Ulrich Stierle, MD, Efstratios I"— Presentation transcript:

1 Fourteen years' experience with 501 subcoronary Ross procedures: Surgical details and results 
Hans-H. Sievers, MD, Ulrich Stierle, MD, Efstratios I. Charitos, MD, Thorsten Hanke, MD, Armin Gorski, MD, Martin Misfeld, MD PhD, Matthias Bechtel, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 140, Issue 4, Pages e5 (October 2010) DOI: /j.jtcvs Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Probability of survival comparing the Ross subcoronary patient group with the age- and gender-matched general population. CI, 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Freedom from autograft reoperation. CI, 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Freedom from homograft reoperation, CI, 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Freedom from autograft and homograft reoperation. CI, 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

6 Excision of the autograft
Excision of the autograft. Usually a muscle band (X) in the right ventricular outflow tract indicates the location of the septal branches (tip of scissors). The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

7 Preparation of the autograft
Preparation of the autograft. The autograft is trimmed leaving only a 1- 2-mm rim of muscular tissue and incising the interleaflet triangle slightly in a scalloped fashion. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

8 Implantation of the autograft
Implantation of the autograft. This schematic drawing shows the suture line (broken red lines) following the attachment of the former aortic valve leaflets halfway up to the commissures. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

9 Implantation of the autograft
Implantation of the autograft. Sutures of the proximal suture line are placed close to the scalloped attachment of the semilunar leaflets of the pulmonary autograft. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

10 Implantation of the autograft
Implantation of the autograft. The autograft (A) is sutured side by side to the annulus of the aortic root (AR). The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

11 Implantation of the autograft
Implantation of the autograft. One U-stitch is used first, followed by 3 over-and-over single stitches. This series of sutures is then repeated all around the annulus (A, autograft; AR, aortic root). The U-stitches are helpful for traction and positioning the autograft into the root. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

12 Implantation of the autograft
Implantation of the autograft. A strip of polytetrafluoroethylene or a 2-0 polytetrafluoroethylene suture is integrated in the proximal suture line to reduce and stabilize a dilated annulus. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

13 Implantation ofthe autograft
Implantation ofthe autograft. The commissure of the autograft (1) is hitched up roughly 1cm above the commissure of the corresponding aortic root (2). The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

14 Implantation of the autograft
Implantation of the autograft. The distal sinus suture line using 5-0 Prolene polypropylene continuously is completed. A pericardial patch (X) is integrated in this case into aortotomy closure line to adjust a narrowed sinotubular junction of the aortic root to the autograft dimensions. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

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