Technical evolution of the Ross operation: Midterm results in 186 patients

Background. The Ross operation approaches the ideal aortic valve replacemen t. Between February 1995 and February 2000 we performed 186 procedures. Thi s article reviews modifications introduced reflecting our experience. Methods. In all patients the Ross operation was performed as root replaceme nt. Echocardiographic follow-up was complete in 94% of patients. Results. No operative death or early mortality occurred, nor did thromboemb olic or hemorrhagic events. One patient died at 25 months from hemoptysis w ith pulmonary valve vegetations. Three patients required reoperation for au tograft insufficiency. In 1 patient a tethered cusp was repairable and in 2 patients progressive autograft dilatation required autograft replacement. After routinely incorporating support into the aortic annulus and replacing all dilated ascending aorta, autograft dilatation did not recur. For the p ulmonary homograft, one outflow patch was placed to relieve a symptomatic g radient. Nine patients with elevated gradients were under observation. Echo cardiography revealed autograft median peak systolic gradients of 4.6 +/- 2 .8 mm Hg, pulmonary homograft gradients of 14.8 +/- 9.6 mm Hg, and nil or i nsignificant regurgitation. Conclusions. The aortic annulus must be supported and the dilated ascending aorta replaced. Root replacement with a short autograft allows consistent results. Pulmonary homograft dysfunction is rare but unpredictable. (C) 200 1 by The Society of Thoracic Surgeons.