Echocardiographic follow-up after Ross procedure in 100 patients

The Ross procedure could provide an ideal aortic valve replacement method i n children and young adults. We evaluated midterm echocardiographic results to assess pulmonary homograft function as well as pulmonary autograft dime nsions and function. In all, 105 patients (26 women and 79 men) underwent t he Ross procedure; median age at implant was 29 years. All patients underwe nt free root replacement. Transvalvular gradients and autograft dimensions were measured at 3 levels (annulus, sinuses of Valsalva, and proximal aorta ) at discharge, at 6 months, and annually thereafter. Perioperative mortali ty was 4.7%. The mean period for echocardiographic follow-up in 100 patient s was 32.7 months (range 0.5 to 7 years), during which 4 noncardiac-related deaths occurred. Two patients underwent tate reintervention. No moderate o r severe regurgitation was recorded. There was 1 case of mild homograft reg urgitation and 4 of mild autograft regurgitation at late follow-up. Autogra ft peak gradients were low and reproducible (5 +/- 2.8 mm Hg at discharge v s 5.5 +/- 3.5 mm Hg at last follow-up, p = NS). Homograft peak gradients in creased significantly without severe obstruction (7.8 +/- 5.7 mm Hg at disc harge vs 15.8 +/- 9.2 mm Hg at last follow-up). The diameter of the autogra ft annulus was stable during follow-up, whereas autograft dimensions at sin uses and proximal aorta increased significantly. One group of patients was identified with sinus diameter increases >20% (group A). The 90 remaining p atients were classified into group B. The only parameter significantly diff erent between the 2 groups was the sinus diameters measured at discharge (1 .74 cm/m(2) (group A) vs 1.92 cm/m(2) (group B); p = 0.036). In 100 patient s and with echocardiographic follow-up for up to 7 years, the pass procedur e showed excellent results. For 10% of patients, we observed a 20% dilation of sinus diameters, but in only 3 patients (3%) was this beyond the upper normal limit. (C)2000 by Excerpta Medico, Inc.