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Ann Thorac Surg 1999;67:750
© 1999 The Society of Thoracic Surgeons

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Commentary

^a Department of Pediatric Cardiology, University of Oklahoma Health Sciences Center, PO Box 26307, Oklahoma City, OK 73126, USA

Invited commentary

The report by Roughneen and colleagues is thought-provoking and innovative in their attempt to circumvent the problem of homograft valve tissue reconstruction of the right ventricular outflow tract after the Ross procedure. Most patients with aortic valve disease have normal right heart structure and function, and the incidence of significant elevation of pulmonary artery resistance is very low in this subset of patients. Thus, replacement of the pulmonary valve with a nonstenotic but regurgitant aortic valve leads to a very acceptable hemodynamic situation on the pulmonary side of the circulation. Although homograft valve conduits in the right ventricular outflow tract work well acutely with regard to minimal regurgitation, many of these homografts will develop shortening and contracture of the leaflets, so that they become significantly insufficient within a year or two after operation. Thus, if one can use primarily autologous tissue that will not become stenotic in the right-sided reconstruction, the result should be at least as good as, and maybe better than, the intermediate-term results using cryopreserved homografts. I am concerned, however, about their finding that more than half of the patients have pulmonary valve Doppler gradients that suggest mild resting obstruction. Whether this will be progressive remains to be seen, and we look forward to further reports and follow-up from this group of investigators.

I believe that the most exciting and "present-day" implication of this new technique is the obvious cost-savings that could be realized if this technique gains widespread acceptance and is proved to have the durability of the prosthetic valve. In the present-day era of conservation of resources, the idea of "valve recycling" is intriguing and should promote further laboratory investigation and clinical application of this technique to try and answer these questions. I look forward, in anticipation, to further research in this very exciting area of cardiac operation.

Related Article

Semilunar valve switch procedure: autotransplantation of the native aortic valve to the pulmonary position in the ross procedure

Patrick T. Roughneen, Serafin Y. DeLeon, Benjamin W. Eidem, Neil J. Thomas, Frank Cetta, Dolores A. Vitullo, Kathy E. Magliato, Teresa E. Berry, and Mamdouh Bakhos
Ann. Thorac. Surg. 1999 67: 745-750. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ward, K. E. Search for Related Content PubMed Articles by Ward, K. E. Related Collections Related Article