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(Circulation. 2005;112:I-415 – I-422.)
© 2005 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Ross Procedure and Left Ventricular Mass Regression

Lennart F. Duebener, MD; Ulrich Stierle, MD; Armin Erasmi, MD; Matthias F. Bechtel, MD; David Zurakowski, PhD; Jürgen O. Böhm, MD; Cornelius A. Botha, MD; Wolfgang Hemmer, MD; Joachim-Gerd Rein, MD; Hans-H. Sievers, MD, on behalf of the German Ross Registry

From the Department of Cardiac Surgery (L.F.D., U.S., A.E., M.F.B., H.-H.S.), University Hospital of Schleswig-Holstein, Campus Luebeck, Germany; the Department of Cardiac Surgery (J.O.B., C.A.B., W.H., J.-G.R.), Sana Herzchirurgische Klinik Stuttgart, Germany; and the Department of Biostatistics (D.Z.), Children’s Hospital Boston, Harvard Medical School, Boston, Mass.

Correspondence to Prof Dr med Hans-H. Sievers, Klinik für Herzchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail h.sievers{at}herzchirurgie-luebeck.de

Background— Return of left ventricular mass to normal is considered to be a favorable result of aortic valve replacement. The Ross procedure provides near normal hemodynamics and thus allows studies of left ventricular (LV) reverse remodeling. LV mass regression may be influenced by surgical technique (subcoronary [SC] versus root replacement [RR]).

Methods and Results— Data from the German Ross Registry were analyzed. A total of 646 patients (mean age: 43.6±12.7 years, range: 16 to 71 years; SC technique n=295, RR technique n=351) underwent a Ross procedure in 7 participating centers from 1990 to 2004. The patients underwent preoperative and postoperative echocardiographic evaluations. Mean follow-up time was 3.5±2.5 years (range 0.12 to 13.7 years). Follow-up completeness was 97%. The LV mass index (LVMI) decreased significantly during follow-up in both groups (SC: 209±53 preoperatively to 154±48 at 1-year follow-up, [P<0.01 versus preoperative values] to 149±51g/m² at 2-year follow-up, [P=NS 1-year versus 2-year follow-up] versus RR: from 195±56 preoperatively to 144±51 at 1-year follow-up [P<0.01 versus preoperative values] to 140±49g/m² [P=NS 1-year versus 2-year follow-up]). LVMI regression remained stagnant 1 year after the Ross procedure in most patients in both groups. On the basis of multivariate analysis, predictors for incomplete LVMI regression after the autograft procedure were high preoperative LVMI, smoking, and uncontrolled diastolic hypertension.

Conclusions— At mid-term echocardiographic follow-up, patients of both groups had favorable autograft hemodynamics. Risk factors for incomplete postoperative LVMI regression in our study were smoking and persistent diastolic hypertension. This emphasizes the importance of cessation of smoking and treatment of arterial hypertension, even in younger patients, after corrected aortic valve disease.

Key Words: valves • surgery • remodeling • risk factors • hypertension

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