CURRENT TECHNIQUES TO REDUCE BLOOD-LOSS AFTER THE ROSS PROCEDURE

Background and aims of the study: Although pulmonary autograft (PA) of fers many theoretical advantages, the operation is more complex and th e need for extensive reconstruction carries an increased risk for post operative bleeding. The study aim was to evaluate the impact of differ ent pharmacological and surgical strategies on total blood loss and bl ood product requirements after PA use. Methods: Between July 1994 and March 1997, 26 patients (22 males) with a mean age of 26 +/- 8 years ( range: 11 to 36 years) underwent aortic valve replacement with PA (22 root; four subcoronary implant). A relatively high incidence of re-exp loration for bleeding (n = 3) and significant total blood loss during our early experience (Group I, n = 8), prompted the subsequent introdu ction of different strategies (Group II, n = 18). These included perio perative use of aprotinin, reinforcement of suture lines of the neo-ao rtic root with autologous pericardium and accurate hemostasis of the r aw surface on the back of the right ventricular outflow tract (RVOT) d uring a brief period of circulatory arrest, also with application of f ibrin glue. Results: There were no hospital deaths. No patients in gro up II required re-exploration or transfusion, and mean total postopera tive blood loss was reduced (group I, 720 +/- 465 ml/m(2) body surface area (BSA), versus group II, 323 +/- 84 ml/m(2) BSA). By-pass and aor tic cross-clamp times were not significantly longer in group II patien ts. At a mean follow up of 15 months, all 25 survivors are asymptomati c, in NYHA functional class I, and with normal social interactions. Co nclusions: Early survival after aortic valve replacement with the PA a ppears comparable with the use of more conventional valve substitutes. Blood loss containment by routine application of medical and surgical strategies appears feasible. In view of the common concern about bloo d transfusion, particularly in young patients, these findings may help to widen the range of indications for the Ross procedure.