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(Circulation. 1999;100:II-36.)
© 1999 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Right Ventricular Function After Pulmonary Autograft Replacement of the Aortic Valve

Gerald S. Carr-White, MRCP; Mark Kon, FRCS; T. W. Koh, MRCP; Sally Glennan; Francis D. Ferdinand, MD; Anthony C. De Souza, FRCS; John R. Pepper, FRCS; Dudley J. Pennell, FRCP; Derek G. Gibson, FRCP; Magdi H. Yacoub, FRS

From the Departments of Academic Surgery (G.S.C.-W., M.K., S.G., F.D.F., A.C.d.S., J.R.P., M.H.Y.), Cardiology (T.W.K., D.G.G.), and Diagnostic Imaging (D.J.P.), National Heart and Lung Institute, Royal Brompton Hospital, London, UK.

Correspondence to Professor Sir Magdi Yacoub, Professor of Cardiothoracic Surgery, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom. E-mail g.carr-white{at}rbh.nthames.nhs.uk

Background—The pulmonary autograft operation (the Ross procedure) involves excision of a portion of the right ventricular (RV) outflow tract, prolonged cross-clamp times, and insertion of a pulmonary homograft. There is concern about the effect of such operations on right ventricular function.

Methods and Results—Twenty-five patients undergoing either pulmonary autograft or homograft replacement of the aortic valve as part of a prospective randomized trial had echocardiographic RV long-axis measurements performed before surgery and 6 months (range 3 to 12 months) after surgery. In all patients, systolic excursion (SE) and both shortening and lengthening rates (SR and LR, respectively) were reduced postoperatively (P<0.05) (homografts: SE 1.5±0.4 versus 2.3±0.6 cm, SR 6.8±2.1 versus 9.6±3.1 cm/s, LR 6.0±1.8 versus 8.9±3.0 cm/s; autografts: SE 1.4±0.4 versus 2.2±0.4 cm, SR 5.8±3.0 versus 8.2±3.0 cm/s, LR 5.7±1.9 versus 8.5±3.7 cm/s). There were no differences between the 2 groups. Eighteen patients who had undergone either aortic homograft or pulmonary autograft surgery were studied between 6 and 35 months after surgery. RV volumes were assessed with the use of MRI in addition to echocardiographic RV long-axis measurements. Global volumes were increased to a similar amount in both groups (homografts: end-diastolic volume 145±34 mL, end-systolic volume 78±23 mL; autografts: end-diastolic volume 157±33 mL, end-systolic volume 89±25 mL; P=NS), whereas stroke volumes were maintained in both groups (homografts 67±15 mL, autografts 67±16 mL; P=NS). RV SE was depressed in both groups to a similar degree to that seen with the previous group (homografts 1.5±0.3 cm, autografts 1.4±0.2 cm).

Conclusions—Aortic valve replacement with either a pulmonary autograft or an aortic homograft leads to a degree of persistent RV longitudinal dysfunction that is not more pronounced in those undergoing the Ross procedure. The mechanisms and long-term effects of these changes must be further studied.

Key Words: aorta • valves • grafting • ventricles • magnetic resonance imaging • echocardiography