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| When is the Ross Procedure a Good Option to Treat Aortic Valve Disease? | |
Tirone E. David, Anna Woo, Susan Armstrong, Manjula Maganti; Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada
Methods: A cohort of 212 patients (mean age 34±9 years, 66% men, 82% with bicuspid aortic valve disease = BAV) had the Ross procedure and was prospectively followed with clinical evaluations and echocardiography from 1 to 19 years, mean of 9.5±3.7 years. In addition to longitudinal outcomes by Kaplan-Meier analysis, numerous perioperative variables were entered into a multivariable analysis to identify predictors of failure of the procedure. Results: There were one operative and four late deaths, none valve-related. The survival at 15 years was 96.6±1.5% and identical to the general population matched for age and gender. There were 18 reoperations: 11 in the pulmonary autograft, 3 in the pulmonary homograft and 4 others. At 15 years the freedom from reoperation in the pulmonary autograft was 93.0±2.2%, and the freedom from moderate or severe aortic insufficiency (AI) was 90±3%. Cox regression analysis identified preoperative AI due to BAV as independent predictors of AI >2+ (H.R. = 3.9; 95% C.I. 2.4 - 5.4). The technique of implantation of the autograft had no effect on the development of late AI >2+. There was no reoperation due to AI in patients with aortic stenosis. At 15 years the freedom from moderate to severe pulmonary insufficiency and/or peak gradient >40mmHg was 88.8±2.6%, and the event-free survival was 87.0±2.8%. Conclusion: The Ross procedure should not be performed in patients with AI due to BAV. The long-term results in patients with aortic stenosis with or without BAV are excellent. This operation is an option for young adults with aortic stenosis who choose a tissue valve. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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