Hemodynamic performance during maximum exercise in adult patients with theRoss operation and comparison with normal controls and patients with aortic bioprostheses

This study examines the resting and exercise hemodynamic performance of the pulmonary autografts in the aortic position as well as of the homografts u sed for right ventricular outflow reconstruction in patients undergoing the Ross operation. Previous studies have reported excellent resting hemodynam ics in patients who underwent aortic valve replacement with ct pulmonary au tograft. However, there are very few studies of their hemodynamic performan ce during exercise. Twenty adult subjects who underwent the Ross operation and 12 normal control subjects were submitted to maximum ramp bicycle exerc ise. The valve effective orifice areas and transvalvular gradients of both aortic (autograft) and pulmonary (homograft) valves were measured of. rest and at peak of maximum exercise using Doppler echocardiography. Valve areas were indexed for body surface area. The hemodynamics of the aortic valve w ere very similar in Pass subjects and in control subjects at rest and durin g exercise. However, the indexed valve area of the pulmonary valve at rest was significantly (p <0.001) lower in the Pass subjects (1.10 +/- 0.46 cm(2 )/m(2)) than in the control subjects (1.95 +/- 0.41 cm(2)/m(2)), resulting in higher (p = 0.004) mean gradients at rest (Ross: 9 +/- 7 mm Hg vs contro l: 2 +/- 1 mm Hg) and at peak exercise (Ross: 21 +/- 14 mm Hg vs control: 7 +/- 2 mm Hg). The pulmonary autograft provided excellent hemodynamics in t he aortic position either at rest or during maximum exercise, whereas moder ately high gradients were found during exercise across the homograft implan ted in the pulmonary valve position. Future improvement of the pass procedu re should be oriented coward the search of new methods to prevent the deter ioration of the homografts. (C)2000 by Excerpta Medico, Inc.