Size and distensibility of the aortic root and aortic valve function afterdifferent techniques of the Ross procedure

Objectives: In the Ross procedure, 3 different techniques are used fur aort ic valve replacement with the pulmonary autograft: freestanding root, inclu sion, and subcoronary implantation. The objective of this study was to eval uate echocardiographically the influence of the particular operative techni que on dimension, distensibility, and valve function. Methods: Between February 1990 and August 1998, the Ross procedure tvas per formed in 111 patients (mean age, 48.6 +/- 14.1 years; range, 15.2-70.6 yea rs), with 1 early and 1 late death, 1 autograft replacement, and 1 patient lost to follow-up. The remaining patients underwent the freestanding root ( n = 9 patients), inclusion (n = 14 patients), and subcoronary techniques (n = 84 patients). Echocardiography was performed at a mean follow-up of 26 /- 21.3 months after operation and was compared with the echocardiographic findings of the control subjects (n = 10 subjects). Root sizes were measure d at the level of the anulus, sinus, and supra-aortic ridge; the distensibi lity was calculated as pressure strain elastic modulus and percent change o f radius. Results: Size and distensibility of the aortic root were normal, except for a larger diameter at the sinus level in the root technique in comparison t o the subcoronary technique (P < .05; maximum diameter, 31.3 +/- 8.6 mm vs 32.6 +/- 4.0 mm). Aortic valve function was comparable among groups with lo w pressure gradients and most patients with no or trace aortic insufficienc y. Conclusions: The freestanding root, inclusion, and subcoronary techniques i n the Ross procedure provide comparable excellent hemodynamics, normal root size, and distensibility, except for the enlarged sinus diameter in the fr eestanding root. These results may have some impact on the operative proced ure and follow-up investigations.