Abstract 19903: Long-term Outcome Following Ross Procedure in Adult Population
Background: There is little data on the outcome of the Ross procedure for the treatment of aortic valve disease in adult patients. The objective of this study was to report the long-term outcome of the Ross procedure in this population and to identify its determinants.
Methods: Between January 1990 and January 2010, 240 consecutive adult patients (mean age: 41±11 years, median: 42; range: 18–59), underwent the Ross procedure. The right ventricular outflow tract was reconstructed with a cryopreserved pulmonary homograft in all patients. Concomitant procedures were performed in 28 (12%) patients.
Results: During a mean follow up of 8.3±4.7 years (2 days – 18 years; mediane: 8.6 years), there were 20 deaths (4 early [1.6%] and 16 late [6.8%]). Among them 12 (60%) were from cardiovascular cause. Overall survival was 98% at 5 year, 92% at 10 years and 83% at 15 years, which was significantly lower compared to age-gender matched population in Quebec (15 years: 96%; p=0.03). Freedom from cardiovascular death was 98% at 5 year, 94% at 10 years and 89% at 15 years. Freedom from reoperation for autograft and/or homograft dysfunction were 98%, 92% and 87% at 5, 10 and 15 years, respectively. Reoperation for homograft dysfunction (stenosis or insufficiency) occurred in 9 patients (3.8%) and reoperation for autograft dysfunction (insufficiency) occurred in 8 patients (3.4%). Homograft size <25mm was the only risk factor for pulmonary homograft failure (p=0.001). The 2 risk factors associated with pulmonary autograft insufficiency were aortic annulus>27mm (p=0.003), and systemic arterial hypertension (p=0.005).
Conclusion: The Ross operation can be performed with satisfactory long-term results in the adult population. The re-operation rate could potentially be reduced by: 1) exclusion of patients with aortic annulus ≥27 mm, 2) oversizing of pulmonary homograft, and 3) aggressive treatment of hypertension.
- © 2010 by American Heart Association, Inc.