Normalization of left ventricular dimensions after Ross operation with aortic annular reduction

Background. Fifty-seven patients (August 1995 to November 1998) with a dysp lastic dilated aortic root, a relative contraindication to the Ross operati on, received an extended Ross operation with aortic annulus reduction and e xternal cuff fixation (age 14-54 years). To assess the efficacy of these op erations, echocardiographic assessment of autograft valve function and left ventricular function and dimensions were reviewed. Methods. Preoperative and postoperative assessment of 27 patients with aort ic insufficiency (AI group) and 30 patients with aortic stenosis (> 20 mm H g peak gradient) and aortic insufficiency (AS group) were compared. Aortic annulus size, valvular gradient, valve insufficiency, left ventricular dime nsions at end-systole and end-diastole, left ventricular fractional shorten ing, and left ventricular mass were assessed. Results. There was one late death. Aortic annulus size, degree of Al, left ventricular interval dimensions, and left ventricular mass were all signifi cantly reduced (p < 0.05) postoperatively in the Al group. Mean peak pressu re gradients for this group were 6.8 +/- 6.7 mm Hg before operation and 8.7 +/- 6.4 mm Hg at 1 year after operation. Peak pressure gradient, aortic an nulus size, degree of AI, left ventricular internal dimensions, and left ve ntricular mass were significantly reduced (p < 0.05) in the AS group. Mean fractional shortening was within normal limits pre- and postoperatively for both groups. Conclusions. Regression of left ventricular dilatation and hypertrophy, exc ellent autograft valve function, and survival suggest that this modificatio n of the Ross operation may be offered to patients with a dysplastic aortic root requiring aortic valve replacement. (Ann Thorac Surg 1999;68:812-9) ( C) 1999 by The Society of Thoracic Surgeons.