Fig. 6.21e. The distal anastomosis of the pulmonary autograft is performed. Courtesy of Dr. Jeff Milliken, Harbor-UCLA.

Fig. 6.21 f. An aortic homograft is prepared for insertion into patient's pulmonary position. Courtesy of Dr. Jeff Milliken, Harbor-UCLA.

Fig. 6.21e. The distal anastomosis of the pulmonary autograft is performed. Courtesy of Dr. Jeff Milliken, Harbor-UCLA.

nique include protection from suture line bleeding, but a disadvantage is that if bleeding does occur between the wrap and the allograft, distortion of the valve leaflets or coronary ostia may occur.

The pulmonary autograft (Ross) procedure for aortic valve replacement involves replacing the patient's aortic valve and root with a pulmonary autograft, then using an allograft in the pulmonary position (Fig. 6.21a-f). The rationale for using such a complex procedure is the increased durability of the pulmonary autograft compared to an allograft in the aortic position. Additionally, the allograft has increased durability in the pulmonary position compared to the aortic position. The procedure has been controversial because of its complexity for what is usually a straightforward operation, and probably should only be performed in experienced centers.

Suggested Reading

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3. Gaasch WH. Aortic valve disease: timing of valve replacement surgery. In Starek PJK, ed. Heart Valve Replacement and Reconstruction. Chicago Year Book Medical Publishers; 1987; 21-29.

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8. Kouchoukos NT, Davila Roman VG, Spray TL, Murphy SF, Perillo JB. Replacement of the aortic root with a pulmonary autograft in children and young adults with aortic valve disease. N Engl J Med 1994; 330:1-6.

9. Frater RVM. Functional anatomy of the mitral valve. In: Ionescu MI, Cohn LH, eds. Mitral Valve Disease. London: Butterworths 1985; 127.

10. David TE, Uden DE, Strauss HD. The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 1983; 68 (Suppl 2); 76-82.

11. Davies MJ. Aetiology and pathology of the diseased mitral valve. In: Ionescu MI, Cohn LH, eds. Mitral Valve Disease. London: Butterworths 1985; 27-41.

12. Gorlin R. Natural history, medical therapy and indications for surgery in mitral valve disease. In: Ionescu MI, Cohn LH, eds. Mitral Valve Disease. London: Butterworths 1985; 105-123.

13. Yacoub M, Halim M, Radley Smith R et al. Surgical treatment of mitral regurgitation caused by floppy values; repair versus replacement. Circulation 1981; 64 (Suppl 2):210.

Peterson KL, Tajimi T. The timing of surgical intervention in chronic mitral regurgitation. In: Duran C, Angell WW, Johnson AD, Ourg JH, eds. Recent Progress in Mitral Valve Disease. London: Butterworths 1984; 171-180. Chaux A, Matloff JM, Czer LSC et al. Clinical results with the St. Jude medical valve. In: Starch PJK, ed. Heart Valve Replacement and Reconstruction. Chicago: Year Book Medical 1987; 191-200

Pipello DF, Bessone LN, Blank RH et al. The porcine bioprosthesis: patient age as a factor predicting failure. In: Bodnar E, Yacoub M, eds. Biologic and Bioprosthetic Values. New York: Yorke Medical Books, 1986; 130-134.

Rivera R, Duran E, Ajuria M. Carpentier's flexible ring versus De Vega's annuloplasty. J Thorac Cardiovasc Surg 1985; 89:196.

Jones EL, Shah VB, Shanewise JS et al. Should the freehand allograft be abandoned as a reliable alternative for aortic valve replacement? Ann Thorac Surg 1995; 59:1397-1404.

Larbelestier RI, Chard RB, Cohn LH. Optimal approach to the mitral valve: Dissection of the interatrial groove. Ann Thorac Surg 1992; 54:1186-8. Horskotte D, Shulte HD, Bircks W, Strauer BE. The effects of chordal preservation on late outcome after mitral valve replacement: A randomized study. J Heart Valve Dis 1993; 2:150-8.

Hennein H, Swain JA, Mcintosh CL et al. Comparative clinical assessment of mitral valve replacement with and without chordal preservation. J Thorac Sardiovasc Surg 1990; 99:828-37.

Akins CW. Selection of cardiac valvular prostheses. Ann Thorac Surg 1993; 55:801-2.

Akens CW, Hilgenberg AD, Buckley MJ et al. Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg 1994; 58:668.

Enriquez-Sorano M, Schaff HV, Orzulak TA et al. Valve repair improves the outcome of surgery for mitral regurgitation: A multivariate analysis. Circulation 1995; 91:1022.

Duram CMG. Tricuspid valve surgery revisited. J Cardiac Surg 1994; 9[Suppl]:242-7.

Cohn LH. Tricuspid regurgitation secondary to mitral valve disease: When and how to repair. J Cardiac Surg 1994; 9[Suppl]:237-41.

Prabhakar G, Kumar V, Gometza B te al. Surgery for organic rheumatic disease of the tricuspid valve. J Heart Valve Dis 1993; 2:561-6.

Baumgartner FJ, Omari B, Robertson JM et al. Annular abscesses in surgicla endocarditis: anatomic, clinical and operative features. Ann Thorac Surg 2000; 70:442-7.

Grossi EA, Steinberg BM, LeBoutillier M et al. Decreasing incidence of systolic anterior motion after mitral valve reconstruction. Circulation 1994; 90:[5Pt2]II:195-7.

Jebara V, Mihaileanu S, Acar C et al. Left ventricular outflow tract obstruction after mitral valve repair: Results of the sliding leaflet technique. Circulation 1993; 88:[5Pt2]II:30-4.

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