The Ross Procedure: Is it the Ideal Operation for the Young with Aortic Valve Disease?

(#1997-RB834)

Francisco Diniz Affonso da Costa, Rita Pinton, Hermínio Haggi Filho, George Soncini da Rosa, Décio Cavalet Soares Abuchaim, Valdemir Quintaneiro, Rodrigo Milani, Robertson Ito, Rogério Gaspar, Martin Burger, Fábio Sallum, Djalma Luiz Faraco, Iseu Affonso da Costa

Heart Surgery Service, Santa Casa de Curitiba and Hospital Infantil Pequeno Príncipe. Curitiba, PR - Brazil

ABSTRACT

Background: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and normalize left ventricular function. This possibly affects long-term prognosis after aortic valve replacement.

Objective: Assessment of hemodynamic performance of pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure.

Methods: Between May 1995 and March 1996, 45 patients with mean age of 27.1 years underwent a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to evaluate the hemodynamic performance of auto- and homografts, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were submitted to dobutamine stress echocardiography to study the hemodynamic performance of auto- and homografts during exercise.

Results: Hospital mortality was 6%. After a mean follow-up of 12.8 months (1-23 months), there was one late sudden death. No valve-related event was observed during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with an average mean gradient of 1.8 ± 0.6 mmHg and an average maximum instantaneous gradient of 2.9 ± 0.9 mmHg. Valvular insufficiency was insignificant. Even during exercise, gradients did not increase significantly with an average mean gradient of 4.3 ± 2.5 mmHg and an average maximum gradient of 10.4 ± 6.1 mmHg. Homografts used for right ventricular reconstruction showed excellent immediate hemodynamic performance. However, at late follow-up an increase in flow speed was observed with an average of mean gradient of 10 ± 7.1 mmHg at rest and 26 ± 13.3 mmHg during exercise. Left ventricular mass index dropped from 168 ± 46 g/m2 preoperatively to 115 ± 32 g/m2 six months after the operation. Left ventricular function was normal at rest and during exercise in the majority of patients.

Conclusion: Given the normal hemodynamic function of pulmonary autografts, the reduction of ventricular mass and normalization of left ventricular function, in addition to the excellent late follow-up of the patients, the Ross procedure is considered the operation of choice for young patients requiring aortic valve replacement.

AUTHOR/ARTICLE INFORMATION

Translated and reproduced with permission from Revista Brasileira De Cirurgia Cardiovascular; 12(2):99-109. Copyright 1997 Francisco Diniz Affonso da Costa, et al.

Address correspondence and reprint requests to: Francisco Diniz Affonso da Costa, Rua Henrique Coelho Neto, 55, Curitiba, PR, Brazil, CEP: 82200-120.