Echocardiographic follow-up study of the Ross procedure in older versus younger patients

Objectives This study was designed to determine echocardiographic follow-up results of the Ross procedure in older adult patients with aortic valve di sease. Background The excellent long-term results of the Ross procedure from sever al institutions have indicated that the pulmonary autograft may be the best available substitute for the diseased aortic valve in children and adolesc ents. The advantages of this operation include optimal hemodynamics and eli mination of thromboembolic complications. These features may benefit older adult patients as well. Methods We reviewed data From 49 consecutive patients who had a Ross proced ure between 1991 and 1996. Preoperative and postoperative Doppler echocardi ographic studies were available for 44 patients (22 men, 22 women; mean [+/ - SD] age 36 +/- 14 years) who were grouped into <40 (n = 25) and <greater than or equal to>40 years old (n = 19). Measurements included left ventricu lar diastolic volume (LVDV), mass, and ejection fraction (EF); a peak press ure gradient across autograft in the aortic position and homograft in the p ulmonary position; and valvular regurgitation. Results The mean length of echocardiographic follow-up was 36 +/- 16 months . Postoperatively, there was a reduction in LVDV and left ventricular mass in both age groups: 153 +/- 99 mL to 111 +/- 72 mL (P=.015) and 210 +/- 93 g to 152 +/- 54 g (P=.002) for younger patients, 174 +/- 115 mL to 126 +/- 43 mL (P=.17) and 233 +/- 71 g to 215 +/- 65 g (P=.19) for older patients. No significant change in EF was noted in the younger age group. However, in the older age group a significant decrease to EF <25% was found in 2 patie nts 1 year after surgery. Moderate autograft regurgitation was also detecte d in 2 patients: 1 in each age group. Pressure gradients across the autogra ft remained within the normal range in both age groups. Two younger patient s had severe homograft stenosis with peak gradients of 100 and 62 mm Hg. Th e older patients did not demonstrate homograft dysfunction. Conclusions The Ross procedure can be performed in selected older adults wi th aortic valve disease and provides durable valves in both aortic and pulm onic positions for at least 3 years after surgery but may result in less fa vorable left ventricular remodeling compared with that in the younger patie nts. Further follow-up will be necessary to determine the longterm outcome of the Ross procedure in this older adult patient population.