Donald N. Ross

Aortic Regurgitation with Ventricular Septal Defect Surgical Management and Clinical Features

Twenty patients with ventricular septal defect and aortic regurgitation had surgical correction using cardiopulmonary bypass. Direct suture of the ventricular defect through the aorta and repair or replacement of the aortic valve were performed. Homograft replacement of the aortic valve was preferred to repair and was associated with less aortic regurgitation after operation. There were one operative death and one late death due to aortic regurgitation. Follow-up for 1 to 6 years showed that 17 of the 18 survivors have had a satisfactory result.

Homograft valves: is degeneration inevitable?

Since the first successful sub-coronary insertion (Ross 1962), the homograft aortic valve has been the favourite amongst many rypes of mechanicai or biological cardiac vaive repiacements ar the National Heart Hospital. Recent srudies on long rerm patient survivai afrer homograft insertion have reveaied excelient results (Bodnar er ai 1979), surpassed oniy by the autotranspianted puimonary valves. (Ross 1967; Ross et ai 1979). Ir is generally accepted that homograft vaives inserred into the aorric position have two major advantages (Ross 1962), they are non-thrombogenic, and (Bodnar et ai 1979) their haemodynamic performance is identicai to that of a normal aortic valve. However, two major disadvanrages are often reported as weii (Ross 1962): difficuities in the coilection, preparation and storage of these vaives, and (Bodnar et ai 1979) the rapid degenerarion which affects. the function of the homograft (Stinson et ai 1977; Anderson and Hancock 1976; Lefrak and Starr 1979). An analysis of the overali performance of the homograft vaive in the aortic posirion has show satisfactory long term resuits (Bodnar et ai 1979). The present work focuses attention on the degeneration of homograft valves in terms of incidence, onser and pattern.

Solution for the Complex Left Ventricular Outflow Tract Lesions

The technique of total aortic root and valve replacement with a “fresh” aortic homograft was introduced by Ross in 1972, and the surgical technique was described [1].

Aortic valve replacement with homograft and autograft valves. Performance of 615 valves over 15 years.

SUBSTITUICAO DA VALVULA AORTICA COM HOMO E AUTOENXERTOS E analisado o comportamento, por um periodo de mais de 15 anos, de 6/5 homoenxertos e autoenxertos em posicao aortica. A incidencia de morte relacionada com o enxerto foi de 6,7%. A frequencia de tromboembolismo foi de 1 por 2314 doentes-anos. A insuficiencia valvular foi mais frequente no caso de homoenxertos « freeze-dried ». A endocardite infecciosa foi rara. Pensa-se que poucos homoenxertos continuarao a funcionar bem 20 anos apos a implantacao, mas 42% entrarao na 2a decada de existencia sem terem tido complicacoes. Os autoenxertos revelaram uma incidencia muito menor de degenerescencia. Muitas das complicacoes associadas com os homo e autoenxertos aparecem gradualmente uma reintervencao electiva