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Eur J Cardiothorac Surg 2004;26:1087-1091
© 2004 Elsevier Science NL

Modified Ross procedure using a conduit with a synthetic valve

Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 2-5-1 Tojin-machi, Chuo-ku, Fukuoka 810-0063, Japan

Received 3 June 2004; received in revised form 20 August 2004; accepted 25 August 2004.

^* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan. Tel.: +81 59 232 1111/5503; fax: +81 59 231 5145. (E-mail: shin1111{at}clin.medic.mie-u.ac.jp).

Objective: In the Ross procedure, a homograft conduit is commonly used in place of an autotransplanted pulmonary valve. Homograft availability may be a problem and has resulted in a search for alternatives. We performed a modified Ross procedure for right ventricular outflow tract reconstruction with a synthetic valved conduit as an alternative to homograft. Our early results of valvular and right ventricular function were evaluated in patients who used a conduit with a synthetic valve. Methods: Subjects consisted of 11 patients, who ranged in age from 5 to 22 years (12.0±4.9), and whose body weight ranged from 15.1 to 52.5 (34.3±14.4) kg. Indications for surgery were aortic stenosis (n=3), aortic stenosis and regurgitation (n=4), and aortic regurgitation (n=4). Right ventricular outflow tract reconstruction was performed using a hand-fashioned valved conduit prepared by sewing a 0.1mm thick polytetrafluoroethylene sheet onto the luminal cavity of the 20–28mm conduit. A conduit made with polytetrafluoroethylene was used in 8 patients, and a Dacron graft was used in 3 patients. Results: There was no in-hospital or late mortality and angiocardiography at discharge revealed that all artificial valves remained active. The mean right atrial pressure and right ventricular end-diastolic pressure were not statistically different from preoperative values. The latest echocardiography (mean interval, 12.6 months) revealed that a mean pressure gradient across the synthetic valve was 11.4±11.1mmHg and none of the patients had moderate or severe regurgitation. Conclusions: We demonstrated that a modified Ross procedure for right ventricular outflow tract reconstruction using a conduit with an appropriate synthetic valve is particularly effective in older children.

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