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Original Articles: Adult Cardiac

A Single-Institution Experience With the Ross Operation Over 11 Years

^a Sana Cardiac Surgical Clinic, Stuttgart, Germany
^b Department of Medical Biometry, Eberhard-Karls-University, Tuebingen, Germany
^c Cardiac Clinic Bodensee, Konstanz, Germany

Accepted for publication October 30, 2008.

^_* Address correspondence to Dr Böhm, Mühlrain 74 b, Stuttgart, D-70180, Germany (Email: joboehm{at}z.zgs.de).

Background: Although the Ross operation requires double-valve replacement for aortic valve pathology, it is the only autologous, aortic valve replacement available. We report a single-unit's 11-year experience.

Methods: Before August 2006, 467 patients (mean age, 41 ± 15 years; 358 males) underwent a Ross operation. The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft. Follow-up was 94.4% complete.

Results: The 30-day mortality was 0.6%. The Kaplan-Meier survival estimate at 120 months was 94.4% ± 2.9% (standard error [SE], 0.0146). Reoperation was due to autograft failure in 15 patients (7 repairs, 8 replacements), with a Kaplan-Meier freedom from autograft failure measured as reoperation or regurgitation exceeding grade II at 120 months of 94.2% ± 2.8% (SE, 0.0142). Homograft replacement, mostly due to stenosis, occurred in 11 patients. Freedom from homograft dysfunction, defined as homograft reoperation or peak homograft gradient of 30 mm Hg or more, at 120 months was 79.3% ± 7.3% (SE, 0.0372). Freedom from all autograft- and homograft-related reoperations at 120 months was 85.9% ± 6.3% (SE, 0.0321). Autograft or homograft endocarditis occurred in 8 patients, and 1 patient had simultaneous endocarditis of both valves.

Conclusions: Patient survival and freedom from prostheses-related events over 11 years still compares favorably with conventional heart valve prostheses. Mortality and morbidity remain low. Reoperation for autograft or homograft failure is higher than our previous reports, and endocarditis is also evident, 1.9% (9 of 467). Homograft dysfunction is higher in younger recipients.