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Original Articles: Adult Cardiac

The Ross Procedure in Adults: Long-Term Follow-Up and Echocardiographic Changes Leading to Pulmonary Autograft Reoperation

^a Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
^b Department of Cardiothoracic–Vascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy

Accepted for publication April 1, 2008.

^_* Address correspondence to Dr Ranucci, Department of Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, 20097, Italy (Email: cardioanestesia{at}virgilio.it).

Background: This is a clinical investigation of the mid- to long-term follow-up of the Ross procedure in adult patients. The primary end point is to explore the incidence and risk factors for a reoperation on the pulmonary autograft. The secondary end points are to explore the incidence of neoaortic root dilation and valve regurgitation, and the echocardiographic profile leading to a reoperation.

Methods: Ross operations were done in 110 adults who received at least two echocardiographic examinations for a mean follow-up time of 82 months (range, 5 to 155 months). Kaplan-Meier and Cox regression analyses were applied to assess freedom from events and risk factors for events.

Results: Freedom from reoperation on the pulmonary autograft, neoaortic root dilation, and moderate-severe neoaortic valve regurgitation were, respectively, 91.4%, 50%, and 70% at 12 years. The main risk factor for a reoperation was the degree of neoaortic valve regurgitation within the first 2 years of follow-up. Patients requiring an early (4 years) reoperation had early and severe pulmonary autograft valve regurgitation, and no neoaortic root dilation. Patients needing a late (>4 years) reoperation had severe neoaortic root dilation and severe neoaortic valve regurgitation. The left ventricular end-diastolic diameter at the third year of follow-up was a risk factor for late reoperation.

Conclusions: The Ross operation in adults is a safe procedure with good clinical results in mid- to long-term follow-up. Early reoperations are due to early neoaortic valve regurgitation, wheras late reoperations are due to progressive neoaortic root dilation.

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Invited Commentary

Marc A.A.M. Schepens
Ann. Thorac. Surg. 2008 86: 489-490. [Extract] [Full Text] [PDF]

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				M. A.A.M. Schepens Invited commentary. Ann. Thorac. Surg., August 1, 2008; 86(2): 489 - 490. [Full Text] [PDF]