Results of the ross operation in rheumatic versus non-rheumatic aortic valve disease

Background and aim of the study: A total of 213 patients underwent the Ross operation at our institution between January 1990 and January 1999. Outcom e was assessed in rheumatic (RH) patients and compared with that in patient s with other etiology (non-RH). Methods: After exclusion of 69 patients with a follow up of <18 months, the study group comprised 144 patients (119 RH, 25 non-RH). Patients were stud ied clinically and by echo-Doppler cardiography preoperatively, within 2 mo nths and 6-8 months after surgery, and yearly afterwards. Preoperative asse ssment included age, gender, body surface area (BSA), type of aortic valve lesion and additional valve disease, left and right ventricular outflow tra ct (LVOT, RVOT) dimensions, and left ventricular (LV) size, function and ma ss. Postoperatively, patients were studied for presence and severity of aut ograft regurgitation, mitral regurgitation, LV size, function and mass, and incidence and timing of reoperation. Results: On average, RH patients were older and had higher BSA, more aortic regurgitation than stenosis, more additional mitral valve disease (mostly regurgitation), larger LV size and poorer LV function. Mitral valve repair was performed in 24% of RH patients versus 0% of non-RH patients. Postopera tively, differences in LV size, function and mass remained present, but dim inished during follow up. The autograft reoperation incidence was 22% (26/1 19) in RH patients versus 8% (2/25) in non-RH patients (p = NS). Preoperati ve predictors for reoperation in the RH group were severe concomitant mitra l regurgitation (MR), followed by male gender and large indexed LVOT tall p <0.001 by discriminant analysis). Conclusion: Marked differences were present in patient characteristics betw een rheumatic and nonrheumatic patients who underwent the Ross operation. R heumatic patients had a higher incidence of autograft reoperation. Severe c oncomitant MR was the most important predictor for reoperation in rheumatic patients.