Dilation of the pulmonary autograft after the Ross procedure

Objective: Dilation of pulmonary autograft after the Ross procedure is bein g recognized with increasing frequency, This study was undertaken to examin e the extent of this problem and factors that may be associated ed with it. Methods: The clinical, operative, and echocardiographic data of 118 patien ts who underwent the Ross procedure were reviewed, The mean age of 79 men a nd 39 women was 34 +/- 9 years, range 17 to 57 years. Bicuspid or other con genital aortic valve disease was present in 81% of patients, The pulmonary autograft was sutured as a valve in the subcoronary position in 2 patients, as a root inside of the aortic root: in 45, and was used for complete aort ic root replacement in 71, Teflon felt was not used to buttress the proxima l or the distal anastomosis of the pulmonary autograft, The diameters of th e sinuses of Valsalva, aortic anulus, and sinotubular junction were measure d early and late after the operation with echocardiography. The mean follow -up was 44 months. Results: The diameter of the sinuses of Valsalva increas ed from 31.4 +/- 0.4 mm to 33.7 +/- 0.5 mm (P = .01). Analysis of covarianc e revealed a significant change over time in this diameter, as well as a di fference between operative techniques, with replacement of the aortic root being associated with a higher risk of dilation (P = .0006). In 13 patients the diameter ranged from 40 to 51 mm, The diameter of the aortic anulus de creased in most patients and increased in 15, but there was no interaction between these changes and the operative technique. The diameter of the sino tubular junction increased in patients who had aortic root replacement and decreased in patients who had aortic root inclusion (P = .007). Moderate ao rtic insufficiency developed in 7 patients, and 3 required replacement of t he pulmonary autograft. All patients with moderate aortic insufficiency had dilation of the aortic anulus and/or sinotubular junction, Conclusions: Di lation of the pulmonary autograft after the Ross procedure may occur becaus e of an intrinsic abnormality of the pulmonary root in patients with congen ital aortic valve disease. The technique of aortic root replacement is asso ciated with a higher risk, of dilation of the sinuses of Valsalva and sinot ubular junction than the technique of aortic root inclusion.