Midterm echocardiographic follow-up after Ross operation

Background-The pulmonary autograft (Ross) operation is an attractive treatm ent for aortic valve disease, but hemodynamic follow-up is not well defined . Methods and Results-One hundred thirty-two consecutive patients (62% male, mean age 40+/-11 years) were followed up to 5 years after the Ross operatio n. Echocardiography was performed early (within 30 days), 3 to 6 months, an d yearly after surgery. The valve effective orifice area (EOA) and mean tra nsvalvular gradient of both aortic and pulmonary valves were measured, and transvalvular regurgitation was assessed by using color Doppler echocardiog raphy. EOA was indexed for body surface area. The hemodynamic performance w as excellent for both the aortic and pulmonary valves early after surgery ( gradient, 3+/-4 and 3+/-4 mm Hg, respectively). It remained stable thereaft er for the aortic valve, whereas then was a significant deterioration of th e EOA (-0.74+/-0.82 cm(2)) and gradient (+6+/-8 mm Hg) for the pulmonary va lve, which occurred mostly during the first 6 months after surgery. This he modynamic deterioration resulted in suboptimal (defined as an EOA index <0. 85 cm(2)/m(2)) hemodynamics in 19.3% of the patients, to the extent that 3 (2%) of the 132 patients eventually had to be subjected to further surgery for severe pulmonary valve stenosis. Conclusions-The pulmonary autograft provides continued excellent hemodynami cs in the aortic position, whereas moderately high gradients can be found a cross the pulmonary homograft in some patients. Further studies are necessa ry to identify the factors responsible for the deterioration of the hemodyn amic performance of the homograft in the pulmonary position and to determin e its impact on right ventricular function and clinical status.