Long-term follow-up with Ross procedure at a single institution

Abstract

Objective To study the long-term follow-up results of Ross surgery. Methods Between October 1994 and February 2009, 58 consecutive patients underwent a Ross procedure at our institution. The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft. All patients were scheduled for a yearly study thereafter that ended at the time of death or at closure of the follow-up visit. Mean follow-up was(12.6±5.8) years(range : 4.5 to 18.2 years). Results There were two early deaths(3%)and one late death(2%). Acturial survival at 16 years was(94.8±3.1)%. One patient required reoperation 1.5 years after his first Ross operation. Of the 55 survival patients, 42 patients(76%) were in NYHA functional class Ⅰ and 13 patients(24%) were in NYHA functional class Ⅱ. Grade 1 or grade 2 autograft regurgitation was observed in seven patients(12%) at one year after the surgery. The sinus of Valsalva diameters were all <40 mm in these seven patients. After surgery, freedom from hemodynamically relevant autograft regurgitation was(87.9±2.8)% at 16 years, whose left ventricular function was significantly improved and left ventricular end-diastolic diameter recovered to normal over the long term. None of the patients required reoperation due to pulmonary homograft failure. Conclusion The Ross procedure can be safely performed in patients with aortic valve disease. To date, mortality, morbidity, and reoperation relates are very low. Reasons for these superior results may include the following: diameter of the aortic valve annulus matching that of the pulmonary valve and patients were monitored with antihypertensive medications to keep systolic blood pressure under 120mmHg(1mmHg=0.133kPa) to delay pressure lesions to the pulmonary autograft. Key words: Aortic valve and root; Heart valve replacement; Pulmonary valve