Original article
Adult cardiac
Ross Operation in the Adult: Long-Term Outcomes After Root Replacement and Inclusion Techniques

https://doi.org/10.1016/j.athoracsur.2008.09.031Get rights and content

Background

Dilatation of the pulmonary autograft is a major concern after root replacement for the Ross operation. The inclusion technique would avoid this drawback, but few data are available on the long-term results of this technique. We retrospectively analyze long-term results of both techniques.

Methods

Of 218 patients undergoing the Ross operation between 1991 and 2006, 148 (68%) had root replacement and 70 (32%) underwent the inclusion technique. The mean age of the patients was 40 ± 10 years (range, 16 to 64). Mean follow-up was 94 ± 44 months (range, 13 to 196). Echocardiographic controls were available in 197 patients. Proximal aorta dilatation was defined as diameter > 40 mm.

Results

In the root and inclusion groups, 10-year overall survival was 94% ± 4% and 97% ± 4%, respectively. Freedom from autograft reoperation was 81% ± 10% and 84% ± 13%, respectively. Main cause of reoperation was autograft dilatation in the root group (13 of 16) and valve prolapse in the inclusion group (5 of 6). Freedom from proximal aorta dilatation was 57% ± 12% and 80% ± 15%, respectively. In the root group, dilatations (n = 48) affected systematically the autograft sinuses or sinotubular junction, whereas in the inclusion group, dilatations (n = 10) affected principally the ascending aorta (8 of 10). Freedom from severe autograft regurgitation was 86% ± 9% and 83% ± 13%, respectively. Root technique, follow-up length, and preoperative aortic valve regurgitation were predictors of proximal aorta dilatation.

Conclusions

In the long term, both techniques showed excellent survival and similar rates of autograft failure. For root replacement, autograft dilatation was the main cause of failure. For the inclusion technique, the autograft, but not the ascending aorta, was protected against dilatation and autograft valve prolapse was the main cause of failure.

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)

  • R.C. Elkins et al.

    Pulmonary autograft in children: realized growth potential

    Ann Thorac Surg

    (1994)
  • N.T. Kouchoukos et al.

    Replacement of the aortic root with a pulmonary autograft in children and young adults with aortic-valve disease

    N Engl J Med

    (1994)
  • Cited by (0)

    View full text