Abstract 3712: The Ross Procedure: Long-Term Clinical and Echocardiographic Follow-Up
BACKGROUND: The Ross procedure is used as an alternative to mechanical aortic valve replacement in children and young adults. Dilatation of the pulmonary autograft resulting in neo-aortic valvular regurgitation has limited the intermediate term success of this operation, however, few data are available regarding the long-term outcome.
METHODS: Serial clinical and echocardiographic studies were obtained in all patients who underwent a Ross procedure at our institution. Seventy eight patients (mean age 19 ± 6 years; 71% male) had a long-term follow-up (range 10–16 years; average 12 years). Indication for surgery was aortic regurgitation in 64 patients, stenosis in 3 patients and combined disease in 11 patients. Aortic valve disease was rheumatic in 65 patients, congenital in 8 patients, due to endocarditis in 2 patients and other etiology in 3 patients.
RESULTS: There were no cases of endocarditis or thrombotic complications at the end of the follow-up period and all patients were in NYHA class I (81%) or class II (19%). Reoperation on the pulmonary autograft and/or homograft was required in 34 patients (44%). The main indication for reoperation on the pulmonary autograft in 27 patients was regurgitation. Reoperation on the pulmonary homograft in 7 patients was due to regurgitation and/or stenosis. Thirty patients (46%) with rheumatic heart disease and 4 (33%) with non-rheumatic disease required reoperation. Moderate-severe left and right ventricular systolic dysfunction was noted in 6 and 2 patients, respectively. At last follow-up, 5 of 51 patients without reoperation on the autograft had moderate and none had severe regurgitation of the neo-aortic valve. Freedom from reoperation on the autograft and homograft was 65% and 91%, respectively.
CONCLUSION: Long-term follow-up of patients with the Ross procedure shows good functional capacity, lack of infective and thrombotic complications and adequate preservation of biventricular systolic function. However, this procedure carries a high rate of reoperation particularly on the pulmonary autograft and this appears to be more common in patients with rheumatic heart disease. Further studies are needed to determine the appropriate patients with aortic valve disease who are best candidate for this procedure.