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Ann Thorac Surg 2007;83:1285-1289
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

The Ross Procedure: Clinical and Echocardiographic Follow-Up in 219 Consecutive Patients

Bruno Chiappini, MD, PhD*, Bruno Absil, MD, Jean Rubay, MD, PhD, Philippe Noirhomme, MD, Jean-Christophe Funken, MD, Robert Verhelst, MD, Alain Poncelet, MD, Gebrine El Khoury, MD

Department of Thoracic and Cardiovascular Surgery, Saint Luc Hospital, Université Catholique de Louvain, Brussels, Belgium

Accepted for publication November 21, 2006.

* Address correspondence to Dr Chiappini, Department of Thoracic and Cardiovascular Ssurgery, Saint Luc Hospital, Université Catholique de Louvain, avenue Hippocrate 10, 1200 Brussels, Belgium (Email: bruno_chiappini{at}hotmail.com).

Background: The replacement of the diseased aortic valve with a pulmonary autograft has been shown to provide excellent hemodynamic results and to be associated with low morbidity and mortality rates.

Methods: From 1991 to 2005, 219 patients undergoing the Ross operation were identified. All patients underwent transthoracic echocardiography at discharge and were scheduled for a yearly study thereafter. The echocardiographic study consisted of a morphologic analysis of the pulmonary autograft with measurement of end-systolic diameters at three levels: annulus, sinuses of Valsalva, and origin of the ascending aorta 2 cm above the sinotubular junction. The dynamic analysis evaluated the function of the aortic autograft and the pulmonary homograft. Maximal and mean aortic and pulmonary transvalvular pressure gradients were investigated.

Results: The 30-day mortality was 1.8% (n = 4). Cardiac deaths were not related to the autograft. The 10-year actuarial survival was 95.7% ± 2.1%. Six patients (2.8%) had grade 2 autograft valve regurgitation. No grade 3 or 4 pulmonary regurgitation was identified. At their most recent follow-up, 28 patients (13.1%) had grade 1 insufficiency of the pulmonary homograft, and 10 patients (4.6%) had a peak transvalvular gradient of 17.9 ± 10.2 mm Hg.

Conclusions: Our current experience suggests that replacement of the aortic root with a pulmonary autograft can be safely performed in infants, children, and adults and is associated with low mortality and morbidity rates. It constitutes an elegant alternative to the use of prosthetic valves in the treatment of aortic valve diseases.




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