Cardiopulmonary response to maximal exercise in young athletes following the Ross procedure

Background. Aortic prosthetic devices offer limitations that make them less than optimal valve substitutes because the vast majority are innately obst ructive, especially at increased levels of hemodynamic function. The presen t study is designed to demonstrate the hemodynamics of the pulmonary autogr aft in 11 conditioned athletes who have undergone the Ross (pulmonary autog raft) procedure. Data was compared to a group of 13 age-matched "normal ath letes." Methods. All the Ross athletes had undergone the autograft procedure using the root replacement technique and were at least 3 months into their postre covery phase. All athletes (both normal and Ross) underwent resting transth oracic echo followed by maximal exercise stress test (modified Bruce protoc ol) to exhaustion. Postoperative transesphogeal echocardiogram obtained wit hin 90 seconds documented aortic valve gradient and velocity across the aor tic valve. Results. In the Ross athlete group, maximum heart rate was 188 beats per mi nute, peak aortic valve gradient at rest (mm Hg) 7.69 (mean), velocity acro ss the aortic valve at rest (cm per second) 129.40 (mean), peak aortic valv e gradient at maximal exercise (mm Hg) 16.30 (mean), velocity across the ao rtic valve at maximal exercise (cm per second) 190.00 (mean). In the normal athlete group, maximum heart rate was 176 beats/minute, peak aortic valve gradient at rest (mm Hg) 5.97 (mean), velocity across the aortic valve at r est (cm per second) 120.54 (mean), peak aortic valve gradient at maximal ex ercise (mm Hg) 14.61 (mean), velocity across the aortic valve at maximal ex ercise (cm per second) 190.23 (mean). Conclusion. The pulmonary autograft exhibits hemodynamic characteristics si milar to the normal human aortic valve under conditions of enhanced cardiac output. (C) 1998 by The Society of Thoracic Surgeons.