THE ROSS OPERATION - RESULTS OF EARLY EXPERIENCE INCLUDING TREATMENT FOR ENDOCARDITIS

The Ross operation has been performed for more than 25 years and its p opularity has increased dramatically in recent years, We developed an interest in this procedure through a combination of a basic dissatisfa ction with a device that requires life-long anticoagulation and the be lief that a vital, autologous tissue valve with normal valve morpholog y and hemodynamics would prove to be superior to the mechanical valve, and that these advantages would outweigh the potential drawbacks rela ted to the operation's technical difficulty and the risk of autograft or homograft dysfunction, From December 1992 to November 1992 40 Ross operations as total root replacements in a diverse group of patients b etween 5 and 72 years of age (median 32) were performed at Rigshospita let, Seventeen (43%) of the patients had undergone at least one previo us open heart operation, Eleven patients (28%) required surgery becaus e of ongoing or previous endocarditis, and of these, nine had aortic a nnular destruction and cavity/pseudoaneurysm formation and five had pr osthetic valve endocarditis. Three patients(8%) were operated because of mechanical valve dysfunction. One patient was treated for an ascend ing aortic aneurysm and aortic insufficiency, The remaining 25 patient s were operated because of congenital or acquired aortic insufficiency , stenosis, or both, Ten patients (25%) underwent concomitant procedur es, No mortality or serious complications occurred, Morbidity was limi ted to one case each of total atrioventricular (A-V) block, sternal ps eudarthrosis, minor stroke, and deep vein thrombosis, Thirty-five pati ents had no or trivial, two patients mild, and three patients moderate autograft valve insufficiency during a median follow-up of 8 months ( range 0-23 months), Two patients had pulmonary stenosis, There were no recurrences or new cases of endocarditis. The results of the Ross ope ration in this initial series of patients were satisfactory and encour aging, and particularly so in patients with native or prosthetic aorti c valve endocarditis, Presently, this treatment modality is offered to children with aortic valve disease, to patients with native or prosth etic aortic valve endocarditis, to those with prosthetic valve dysfunc tion and other complications after aortic valve replacement, and to pa tients in whom anticoagulation is contraindicated or undesired.