The Ross operation: Mid-term results

Background. The Ross operation, although more demanding, is now widely acce pted as an alternative solution for aortic valve replacement in young adult s and children. A review of our experience to assess the midterm results wi th the Ross operation is presented. Methods. From June 1991 through October 1997, 80 patients (mean age, 31 yea rs) underwent aortic valve or root replacement with pulmonary autografts. I ndications for operation were predominant aortic stenosis in 38 patients, a ortic incompetence in 42 patients including endocarditis in 3 patients. Con genital lesions were present in 57 patients, either at pediatric (27 patien ts) or adult age (30 patients). Transthoracic echocardiography was performe d preoperatively in all patients and serially after operation with the aims of measuring aortic and pulmonary annuli, evaluating transvalvular gradien ts and incompetence, and studying the left ventricular function. Intraopera tive transesophageal echocardiography was used routinely. Complete root rep lacement was performed in 52 patients, intraluminal cylinder in 25 patients , and subcoronary implantation in 3 patients. Results. One patient died in the early postoperative period (1.2%). There w as no late death. The actuarial survival at 5 years was 98% +/- 1%. All sur vivors remained in New York Heart Association functional class I and were f ree of complications and medications. No gradient or significant aortic inc ompetence could be demonstrated in 73 patients. One patient developed late aortic incompetence grade 3 and reoperation is considered. On the pulmonary outflow tract, 6 patients had gradients between 20 and 40 mm Hg as calcula ted on echocardiography. Conclusions. The pulmonary autograft gives excellent mid-term results with low mortality and no morbidity. It completely relieves the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function in most patients. (Ann Thorac Surg 1999;67:1355-8) (C ) 1999 by The Society of Thoracic Surgeons.