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(Circulation. 2003;108:II-55.)
© 2003 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Midterm Results of the Ross Procedure Preserving the Patient’s Aortic Root

Hans- H. Sievers, MD; Gerlinde Dahmen, MSc; Bernhard Graf, MD; Ulrich Stierle, MD; Andreas Ziegler, PhD; Claudia Schmidtke, MD

From the Clinic of Cardiac Surgery, Institute of Medical Biometrics and Statistics; Department of Cardiology, Klinikum Schwerin, Schwerin, Germany.

Correspondence to Prof. Dr. med. Hans-H. Sievers, Klinik fuer Herzchirurgie, Universitaetsklinikum Luebeck, Ratzeburger Allee 160, 23538 Luebeck. Phone: 49-451-500-2108; Fax: 49-451-500-2051; E-mail: schmidtk{at}medinf.mu-luebeck.de

Background— Since the early 1990s, the pulmonary autograft is predominantly implanted as a freestanding root for less aortic valve regurgitation is reported. However, there is a certain risk of dilatation of the root over time potentially impairing valve function. We favor since 8 years the original subcoronary or inclusion technique to preserve the root of the patient as a restrain to dilatation.

Methods and Results— Between June 1994 and May 2002 the subcoronary (n=228) and inclusion technique (n=17) were performed in 245 patients (191 male, 54 female), mean age 45.7±13.4 (15–70) years. The underlying aortic valve disease was an aortic insufficiency in n=83, stenosis in n=48, a combined aortic valve disease in n=111 and an acute endocarditis in n=19 patients. Previous aortic valve surgery was performed in n=23. Last follow-up investigations (within last year) including echocardiography was performed at a mean follow-up of 29.4±24.7 months (553.7 patient years). Hospital mortality was n=2, late mortality n=4 (all noncardiac). Two patients were lost to follow-up (99% complete clinical follow-up). Reoperations were necessary in n=7 valves (autograft: endocarditis n=1, malpositioning n=1, leaflet prolapse n=1; homograft: stenosis n=2, insufficiency n=2). Autograft insufficiency (AI) was AI 0 in n=154, AI I n=66, AI II n=8. The maximum/mean pressure gradient across the autograft was 6.6±3.4 (2.1 to 25.9)/3.6±1.8 (1.2 to 13.2) mm Hg, respectively. Homograft insufficiency was 0 in n=167, I in n=54, II in n=9, and III in n=1. Maximum and mean transhomograft pressure gradients were 11.7±6.8 (2.2 to 42.6)/6.2±3.8 (1.2 to 24.5) mm Hg. Most patients were NYHA class I (n=214), class II (n=19), class III (n=2). Significant aortic root dilatation was not observed.

Conclusions— Aortic valve replacement with a pulmonary autograft in the subcoronary or inclusion technique provides excellent hemodynamics with no root dilatation at least in a mid term postoperative period. Transhomograft pressure gradients are slightly increased. Longer term results with special emphasis on the pulmonary homograft are necessary.

Key Words: valves • prothesis • surgery