James H. Oury

The Ross procedure: current registry results

BACKGROUND The pulmonary autograft procedure for the treatment of aortic valve disease was developed and performed by Ross in 1967. The results he published in 1987 prompted increasing interest in the procedure. The International Registry of the Ross Procedure was established in 1993 to further examine longitudinal clinical outcomes. METHODS The results from the Ross registry document the continued and growing interest in the procedure with 2,523 patients currently enrolled, representing 122 centers and 166 surgeons worldwide. RESULTS Mortality (1987 to present) reported in the registry is 2.5%. It should be noted that follow-up stands at 70%. The most important issues for the registry to track are the incidence of reoperation for autograft failure and the fate of the pulmonary homograft. Reoperation for all valve-related problems is low (5.4%), with an autograft explant rate of 1.9%. Overall registry data indicate that the right ventricular outflow tract revision rate is 2.8%, with this decreasing by half to 1.3% in the 1987 to present subgroup. CONCLUSIONS Rigorous analysis of outcomes is difficult with registry follow-up currently at 70%; however, the general conclusions derived from the registry are supported by other individual series with excellent follow-up. Success of the registry depends on judicious efforts by all participating surgeons and coordinators in documenting long-term patient results and reporting them to the registry.

Acute coronary embolism complicating bacterial endocarditis: Operative treatment

A patient with bacterial endocarditis and no previous history of angina substained an acute anterolateral myocardial infarction while awaiting surgery. Selective coronary arteriography revealed a filling defect in the left anterior descending coronary artery with limited flow beyond the area of occlusion. A calcific embolus from the infected aortic valve was removed at the time of valve replacement, and the patient had an uneventful immediate postoperative course. Late postoperatively paravalvular aortic regurgitation recurred before and after a second repair.

Expanding indications for the Ross procedure

The pulmonary autograft procedure has been shown to provide excellent hemodynamic results in young patients with aortic pathology. However, the use of this procedure in those with more complex aortic disease has not been extensively evaluated. The purpose of this report is to present the application of the Ross procedure in a 21-year-old man with extensive acquired aortic root pathology, both subannular and supraannular, and prosthetic valve dysfunction after two previous procedures.

Comparison of Hancock I and Hancock II bioprostheses.

The Hancock II bioprosthesis was developed in order to provide the advantageous low pressure fixation, improved deirin stent design, and anticalcification treatment. These changes were made 6 years ago after 10 years of experience with the high pressure fixed rigid implantation ring and polypropylene stent used in the Hancock I valve.

Contrast Echocardiography as an Intraoperative Method to Determine the Area of Myocardium Perfused by Transmyocardial Laser Channels: An Experimental Study

Abstract Objectives: Transmyocardial laser revascularization (TMLR) of the ischemic myocardium has been recognized as a potentially useful adjunct in the treatment of coronary arterial heart disease. Although there are methods to visualize the induced channels, they have been complex or concerned with long‐term patency. The present work was designed as a feasibility study to determine whether contrast echocardiography could provide a simple and rapid method to assist the surgeon in determining the extent of the TMLR‐treated area. Methods: Transmyocardial channels were created in five Targhee adult sheep myocardium using a Holmium‐YAG laser over the area supplied by the second diagonal branch. A commercially developed echocontrast agent (Optison) was injected into the left atrium. Results: Passage of the dye through the myocardium was observed by epicardial echocardiography in all the animals. Conclusion: The current study shows that contrast echocardiography using a newer generation contrast agent capable of enhanced and persistent opacification of left ventricular cavity may serve as an effective tool in delineating intra‐operatively the area of myocardium treated with TMLR.

In Vitro Self-Training in the Surgical Technique of Aortic Valve Repair and Reconstruction

A simple device for in vitro assessment of aortic surgery on an isolated heart or aortic root specimen is described. This device was designed as a simple tool to provide surgeons with immediate and direct visual feedback on the results of a procedure performed on the aortic valve in an isolated cardiac specimen. The objectives were to assess the duration of learning new aortic surgical procedures and to instill a greater sense of confidence to the surgeon prior to operating on a patient. Free-hand pericardial aortic valve reconstructions were performed on 9 pig hearts and 5 human homografts, which were tested with this device. In the pig, valve reconstruction was tested using the whole heart as well as the isolated aortic root. Detailed qualitative and quantitative assessments of the performance of the reconstructed aortic valve were possible using this device.

Mitral valve reconstruction: An underused alternative to replacement

PreviewTo reconstruct or to replace—that is the question. Many more times than not, the answer has been mitral valve replacement when, Dr Grehl and his associates contend, reconstruction would prove more beneficial. Given the safe means of myocardial preservation now available and a surgeon with the experience to use the varied techniques involved, repair of severely diseased valves can be attempted “without jeopardizing myocardial function should replacement eventually become necessary.” In this article, the authors offer a graphic account of the techniques used to correct mitral valve dysfunction.