910-21 Ross Procedure: Is It Really the Ideal Solution?

Abstract

Pulmonary autografts have shown promise in the intermediate and long-term results as being an ideal valve substitute for diseased aortic valve. We have adopted this procedure as an option for aortic valve replacement, especially in the young, growing patients who are difficult to anticoagulate. In the period between Jan 1990 and Aug 1994, we have performed this procedure on 79 patients (pts), 57 (72%) males and 22 128%) females. Their age ranged from 1 – 41 years (yrs) (mean, 18.6 ± 7.36 yrs). The etiology was rheumatic in 62 (79.5%) pts and regurgitation was present in 60 (76.9%). stenosis in 5 (6.4%) and both in 13 (16.7%). Five pts had undergone previous surgery for aortic valve (3 repairs, 2 replacements). Associated mitral surgery was performed in 22 (28.2%) pts all of them undergoing repairs. The mean bypass time for isolated Ross procedure was 117.9 ± 36.6 minutes (mins) (74 – 243 mins) and mean ischemic time 79.8 ± 25.1 mins (46 – 155 mins). The right ventricular to pulmonary artery connection was established in all but one case with homografts. There has been no hospital deaths or documented thromboembolisms to date. There have been 2 (2.2%) late deaths, 1 unrelated and 1 due to systemic sepsis and renal shutdown in a pt with T-cell abnormality and congenital immune deficiency at 12 and 36 months (mos). respectively. Four pts (5%) have been reoperated: 1for mitral valve repair failure and suture line leak with false aneurysm (6 mas) and 3 for autograft failure with progressive regurgitation (20 – 26 mos). One reported valve showed histology compatible with rheumatic valvulitis. Even though the left ventricular dimensions and function show immediate recovery and are maintained in the short follow-up, there is a small but definite progression of the autograft regurgitation followed beyond 6 mos. The effect of sizing: surgical distortion, recurrence of rheumatic activity of these transplanted valves and of the repaired mitral valves remain to be evaluated in the long-term. In conclusion: the Ross procedure, while being a safe and excellent option in the young, growing pts with aortic valve disease, should be moderated by the concerns expressed above.