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Background:
Aortic valve replacement using the patient’s own pulmonary valve (Ross Procedure) has proven to be a procedure with limited risks and good long term results in experienced hands. It is particularly suited for younger patients including neonates and infants. There is concern however in reference to progressive aortic root dilatation with time that may lead to aortic regurgitation (AR) and need for reoperation.
Methods:
January 1990 to December 2012, 537 patients underwent the Ross Procedure at our institutions. Among these, 357 (69% males, mean age 29.4 ± 3.9 years) had complete clinical and echocardiographic follow up (mean 13.4 ±3.9 years). The autograft was implanted as a full-standing root with coronary transfer. Selective aortic root reinforcement was utilized in patients with dilated aortic roots. Seventy four patients with small aortic annulus ± left ventricular outflow tract (LVOT) hypoplasia.
Patients were divided into 2 groups according to pathology (group I with rheumatic etiology and group II with nonrheumatic etiology - mostly congenital aortic valve disease).
Results:
Hospital mortality was low (1.2%). Reoperation was required in 36% of patients with a mean time for redo surgery of 6.7 ± 4.2 years. A second redo surgery was required in 3%. Homograft survival was 13 ± 4 years. Reoperation on the neoaortic valve was required mostly for patients in group I (rheumatic patients with pure aortic valve regurgitation being the main hemodynamic manifestation and with dilated aortic roots >27mm). These were mostly from our early experience. Patients in group II with aortic stenosis being the main hemodynamic manifestation had almost no autograft related reoperations. Children who required the Mini-Ross-Konno procedure showed no progressive AR, no recurrent AS or LVOTO in addition to normal growth.
Conclusion:
Autograft failure is higher in patients with rheumatic etiology, pure AR and dilated aortic root. Avoiding the Ross procedure in this group of patients and restricting it to patients with aortic roots <27 mm and with stenosis as the main hemodynamic manifestation will result in improved long term results.