GEOMETRIC MISMATCH OF THE AORTIC AND PULMONARY ROOTS CAUSES AORTIC-INSUFFICIENCY AFTER THE ROSS PROCEDURE

Background: Geometric mismatch between the two semilunar valves can ca use aortic insufficiency after the Ross procedure, Thus, whenever the aortic root is larger than the pulmonary root, surgical reduction of t he aortic anulus or of the sinotubular junction (or both) to match the diameters of the pulmonary root is necessary to prevent late malfunct ion of the pulmonary autograft, Methods: The Ross Procedure was perfor med in 81 patients during the past 5 years, The diameters of the aorti c and pulmonary roots were measured in 77 patients, Reduction of the a ortic anulus and of the sinotubular junction was necessary in 27 patie nts, reduction of the aortic anulus alone in 12, and reduction of the sinotubular junction alone in 10, The pulmonary autograft was implante d in the subcoronary position in the aortic root in two patients, as a complete root replacement in 58, and as an inclusion root in 21, Resu lts: There was one operative death, caused by myocardial infarction, A ortic insufficiency developed in one patient who did not have measurem ent and reduction of the aortic anulus, and aortic root replacement wa s necessary 2 weeks later, Patients have been followed up from 2 to 64 months (mean 15 months), Two patients have required late reoperations : one because of pulmonary artery stenosis and the other because of a false aneurysm between the autograft and the mitral valve, The most re cent Doppler echocardiographic study shows that 90% of the patients ha ve only trace or no aortic insufficiency, and 10% have mild aortic ins ufficiency, Conclusion: This experience suggests that adjustment of th e diameter of the aortic anulus or of the sinotubular junction of the aorta may be important to prevent aortic insufficiency after the Ross procedure.