Ann Thorac Surg 1996;62:448-449
© 1996 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 442.
DR JOHN H. CALHOON (San Antonio, TX): I thank The Society for the opportunity of discussing this fine report and commend Dr Starnes on taking a very difficult set of children and doing a wonderful job with them. I also thank him for giving me this text; it is very well done and it will be of benefit to all of us.
In San Antonio we, too, have performed three Ross procedures in children I would call neonates with no early deaths, one with interrupted aortic arch and two with isolated aortic stenosis. Our first patient is now about 4 years old, has not required reoperation, and has shown growth in the pulmonary autograft. I agree with Dr Starnes and others now that the Ross procedure is probably the procedure of choice for left ventricular outflow tract obstruction in infants.
I have two questions. In our patient with interrupted aortic arch, left main bronchial compression developed. Do you have any tips that you would like to share with us on avoiding this complication? Also, now that you have experience in this age group, all of whom had prior procedures, do you think there is a place for no prior intervention with a balloon dilation or other palliation in isolated neonatal aortic valve stenosis and proceeding straight to a Ross operation?
DR STARNES: Thank you, Dr Calhoon, for those nice comments. I think in relation to reconstructing the aortic arch and trying to avoid the complication of left bronchial stenosis, we have found that actually bringing the posterior native aortic arch together with the proximal descending aorta can be done without tension if you really immobolize the head vessels completely and also add a homograft augmentation anteriorly.
Whether or not this should be offered as a primary procedure I think is obviously being debated more and more. I think neonates presenting with neonatal critical aortic stenosis probably still need the benefit of a balloon valvuloplasty. And if it fails, I think we should go directly then to the neonatal Ross procedure.
I think some of the palliative operations that we have encountered from other institutions should not be performed. I think the complex lesions of ventricular septal defect and critical aortic stenosis should be approached with the methodology that we propose today.
Related Article
-
Aortic Root Replacement With the Pulmonary Autograft in Children With Complex Left Heart Obstruction
- Vaughn A. Starnes, Giovanni Battista Luciani, Winfield J. Wells, Rosemary B. Allen, and Alan B. Lewis
Ann. Thorac. Surg. 1996 62: 442-448.
[Abstract]
[Full Text]
