ROSS PROCEDURE IN CONGENITAL PATIENTS - RESULTS AND LEFT-VENTRICULAR FUNCTION

Methods: From April 1990 to August 1995, 121 patients (median age 42 y ears) underwent aortic valve replacement with allografts (69 patients) or autografts (52 patients). In this latter group, 24 Ross procedures have been performed in congenital patients since November 1991 (media n age 10 years, range five months to 27 years): aortic incompetence (n = 17), isolated aortic stenosis (n = 5), small stenotic prosthesis (n = 2). Transthoracic echocardiography was obtained preoperatively in a ll patients and serially after surgery with the aim of measuring aorti c and pulmonary annuli and evaluate gradients and incompetence and to study the left ventricular function. Intraoperative transoesophageal e chocardiography was routinely used. Complete root replacement was perf ormed in all patients. Results: One patient died in the early postoper ative period (4%). There was no late death. All survivors remained in NYHA class I and were free of complications and medications. No gradie nt nor any significant aortic incompetence could be demonstrated. In 1 7 patients with predominant aortic incompetence before surgery, the le ft ventricular function was followed prospectively, end-diastolic left ventricular dimensions diminished drastically from 2 +/- 3.4 S.D. abo ve normal to - 0.63 +/- 2.4 S.D. at one week postoperatively (day 10) to reach a normal value one to three months after surgery. Left ventri cular mass remained abnormal at day 10 (from 4.7 +/- 3.3 S.D. to 5.3 /- 3.8 S.D.) and diminished more progressively to reach a normal value (0.14 +/- 1.4 S.D.) at three months. This resulted in a significant d ecrease of end-systolic wall stress (- 3.6 +/- 2.1 S.D.) and in a hype rdynamic function in the immediate postoperative days except in two pa tients. These two patients were characterized preoperatively by more s everely dilated left ventricle (end diastolic dimension 5.3 +/- 0.03 v ersus 1.6 +/- 3 S.D.) with decreased left ventricular wall thickness ( 1.19 +/- 0.7 versus 3.44 +/- 1.9 S.D.), decreased ratio between end di astolic wall thickness and end diastolic dimension (0.14 +/- 0.06 vers us 0.2 +/- 0.06) and a decreased velocity of shortening. Unlike the ot her 15 patients, the left ventricular function did not recover complet ely at mid term follow-up in those two patients. Conclusion: The Ross operation is a safe procedure and allows us to suppress completely the abnormal loading conditions of the left ventricle, resulting in a com plete recovery of left ventricular function in most patients. Copyrigh t (C) 1997 Elsevier Science B.V.