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Original Articles: Pediatric Cardiac

Midterm Results of Ross Aortic Valve Replacement: A Single-Institution Experience

Sections of Cardiothoracic Surgery, James W. Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana

Accepted for publication May 5, 2009.

^_* Address correspondence to Dr Brown, Section of Cardiothoracic Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 215, Indianapolis, IN 46202–5123 (Email: jobrown{at}iupui.edu).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: We reviewed our institutional midterm experience to assess autograft and homograft hemodynamics and reoperative frequency after Ross aortic valve replacement.

Methods: Between June 1993 and January 2009, 212 consecutive patients (mean age, 24.8 ± 15.5 years; range, 1 month to 67 years) underwent Ross aortic valve replacement; 49% were younger than 19 years old. One hundred forty-two additional procedures were required in 101 of the 212 patients (48%) at the time of the Ross aortic valve replacement. One hundred ninety-three patients had isolated aortic valve disease, and 19 pediatric patients had more complex, multilevel left ventricular outflow tract obstruction.

Results: There were 2 early (1%) and 2 late deaths (1%), with a mean follow-up of 7.9 ± 4.2 years (range, 1 month to 15 years). Actuarial survival at 15 years was 98%. To date 28 patients (13%) have required reoperation. At 15 years, freedom from autograft sinus or ascending aortic dilatation was 79%, autograft dysfunction, 91%, autograft reoperation, 89%, and autograft replacement, 96%. Freedom from pulmonary allograft replacement was 96% at 15 years.

Conclusions: The Ross aortic valve replacement can be performed in children and adults with good midterm results. The late complications of autograft regurgitation, sinus or ascending aortic dilatation, can usually be corrected with a valve-sparing root replacement. These complications can often be prevented by (1) aggressive treatment of postoperative systemic hypertension, (2) replacement of a dilated ascending aorta at the initial Ross procedure, or (3) external fixation of the autograft annulus or sinotubular junction. The potential of late autograft insufficiency, ascending aortic and sinus dilatation, or homograft stenosis and insufficiency warrants annual follow-up.

This article has been cited by other articles:

				F. Juthier, A. Vincentelli, C. Pincon, C. Banfi, P. V. Ennezat, S. Marechaux, and A. Prat Reoperation After the Ross Procedure: Incidence, Management, and Survival Ann. Thorac. Surg., February 1, 2012; 93(2): 598 - 605. [Abstract] [Full Text] [PDF]

				J. W. Brown, J. W. Fehrenbacher, M. Ruzmetov, A. Shahriari, J. Miller, and M. W. Turrentine Ross Root Dilation in Adult Patients: Is Preoperative Aortic Insufficiency Associated With Increased Late Autograft Reoperation? Ann. Thorac. Surg., July 1, 2011; 92(1): 74 - 81. [Abstract] [Full Text] [PDF]

				J. W. Brown, M. Ruzmetov, A. P. Shahriari, M. D. Rodefeld, Y. Mahomed, and M. W. Turrentine Modification of the Ross aortic valve replacement to prevent late autograft dilatation Eur J Cardiothorac Surg, May 1, 2010; 37(5): 1002 - 1007. [Abstract] [Full Text] [PDF]