Ross operation--immediate and mid-term results

The Ross procedure has resolved the major problem in the management of aortic valve disease in the young, The operation can be performed in childhood and procedes an ideal valve substitute, which does not require anticoagulation, has growth potential and is free from degeneration.

Short- and mid-term results of 45 patients after Ross procedure (December 1993 through April 1999) were reviewed. The aim of this study was to evaluate postoperative haemodynamic performance of this procedure, to asses the impact of modifications on postoperative results, and to make inferences that may improve results.

There were four early deaths (9%), no late deaths and no reoperations. Thirty-four patients had no or trivial symptoms, six patients had mild symptoms and one patient, moderate regurgitation of neo-aortic valve at the last echocardiographic study. Stenosis was not present at rest or during exercise. An obvious regression of left ventricle hypertrophy was detected (248+/-94-10+/-34 g/m). Reinforcement of the proximal suture line of the pulmonary autograft with pericardial strips does not restrict the growth of the aortic annulus. Dilatation of the aortic root was detected in all patients. The mean gradient through pulmonary homograft was 11.5 mmHg.

The Ross procedure provides optimal haemodynamic function from the neo-aortic valve, leading to regression of left ventricular hypertrophy and near normal life style, without anticoagulation. Dilatation of the neo-aortic root diameter postoperatively was not associated with progressing of regurgitation. Concern still exists over future valve function, particularly in patients with a diagnosis of bicuspid dilated incompetent aortic valves.