Original articleAdult cardiacRoss Operation in the Adult: Long-Term Outcomes After Root Replacement and Inclusion Techniques
Section snippets
Patients and Methods
From June 1991 to October 2006, 218 adult patients underwent Ross operation using the root replacement technique (n = 148; 68%) or the inclusion technique (n = 70; 32%). Operations were carried out at the Cliniques Universitaires Saint-Luc (n = 186; 85%) or at the Cliniques Universitaires Mont-Godinne (n = 32;15%) by one of two senior surgeons (J.R. [51%, root, n = 69; inclusion, n = 43] or G.E.K. [49%, root, n = 79; inclusion, n = 27]). All patients had preoperative transthoracic
Mortality
Three patients (1.4%) died during the early postoperative period (less than 30 days), 1 from massive cerebral bleeding, 1 from sudden death, and 1 from acute pulmonary edema. During the follow-up period, 5 patients died (2 to 7 years after surgery); of them, only 2 died of cardiac causes (arrhythmia, sudden death; Table 2). Ten-year overall survival was 94% ± 4% in the root group and 97% ± 3% in the inclusion group (Fig 1).
Morbidity
Relevant early postoperative complications are listed in Table 2. During
Comment
In this study, we confirm the excellent long-term survival after Ross operation in the adult population. The pulmonary autografts show stable and physiologic behavior regarding transvalvular gradients and thromboembolic or infectious events [3, 4]. However, we showed also an 18% rate of autograft reoperation at 10 years, mainly due to autograft dilatation or regurgitation. Equivalent or slightly higher reoperation rates have already been reported by several others authors using the root and
References (24)
Replacement of aortic and mitral valves with a pulmonary autograft
Lancet
(1967)- et al.
Pulmonary autograft reoperation: incidence and management
Ann Thorac Surg
(1996) - et al.
Does the pulmonary autograft in the aortic position in adults increase in diameter?An echocardiographic study
J Thorac Cardiovasc Surg
(1997) - et al.
Aortic root dilation after the Ross procedure
Am J Cardiol
(1999) - et al.
Dilation of the pulmonary autograft after the Ross procedure
J Thorac Cardiovasc Surg
(2000) - et al.
The Ross procedure: long-term clinical and echocardiographic follow-up
Ann Thorac Surg
(2004) - et al.
The relationship between neo-aortic root dilation, insufficiency, and reintervention following the Ross procedure in infants, children, and young adults
J Am Coll Cardiol
(2007) - et al.
Degeneration of the pulmonary autograft: an explanatory study
J Thorac Cardiovasc Surg
(2006) - et al.
The Ross procedure: valvular pathology of synchronous pulmonary autograft and homograft insufficiency
Hum Pathol
(2007) - et al.
Clinical pulmonary autograft valves: pathologic evidence of adaptive remodelling in the aortic site
J Thorac Cardiovasc Surg
(2004)