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Ann Thorac Surg 2007;83:36-39
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Subcoronary Ross Procedure in Patients With Active Endocarditis

^a Klinik für Herzchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
^b Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

Accepted for publication July 26, 2006.

^_* Address correspondence to Prof Dr Sievers, Klinik für Herzchirurgie UKSH, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany (Email: claudia.schmidtke{at}uni-luebeck.de).

BACKGROUND: The Ross procedure has gained increasing interest as an attractive alternative to a prosthetic aortic valve substitute within the last decade. Because of a probably better resistance to infection as one of its advantages, the pulmonary autograft is theoretically preferable for active endocarditis.

METHODS: Between June 1994 and July 2003, the Ross procedure was performed using the subcoronary and inclusion technique in 296 patients (231 male, 65 female). Twenty patients had an active endocarditis of the aortic valve at the time of operation. A bicuspid valve was present in 10 patients. One patient had previous aortic valve surgery. Clinical and echocardiographic follow-up was complete.

RESULTS: Early mortality was 1, late mortality was 0. There were no recurrence of endocarditis and no neurologic events during the mean follow-up of 47.3 ± 28.6 months. All patients were in New York Heart Association class I. Mean and maximum pressure gradient across the autograft was 3.5 ± 2.0 and 6.5 ± 3.4, respectively, with no autograft insufficiency in 15, 1+ in 4. Comparing postoperative with the last investigations, there were no significant changes of pressure gradients or grade of regurgitation. Mean and maximum homograft pressure gradients were 7.9 ± 3.7 and 16.2 ± 8.1 mm Hg, respectively, at last investigation; most patients had no or mild homograft regurgitation (0+, n = 13; 1+, n = 5; 2+, n = 1).

CONCLUSIONS: Native valve endocarditis can be treated with excellent results using the Ross procedure with the subcoronary and inclusion technique, with low mortality and morbidity rates and a very low recurrence rate of endocarditis.

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