Hemodynamic performance following the Ross operation: comparison of two different techniques

Area of Science:

• Cardiac surgery
• Aortic valve replacement
• Thoracic surgery

Background:

• The Ross operation, a form of aortic valve replacement, has evolved from subcoronary implantation to full-root replacement.
• The optimal technique for the Ross operation remains debated.
• This study compares the hemodynamic performance of two Ross operation techniques.

Purpose of the Study:

• To compare the hemodynamic performance of the full-root replacement versus subcoronary implant techniques for the Ross operation.
• To evaluate autograft and homograft function in mid-term follow-up.

Main Methods:

• A retrospective analysis of 132 patients (root replacement) and 249 patients (subcoronary implant) from the German Ross Registry.
• Clinical and echocardiographic data were analyzed, focusing on pulmonary autograft and homograft function.

Main Results:

• The root replacement technique showed lower autograft peak systolic gradients and higher indexed effective orifice area (EOA) compared to subcoronary implant.
• Pulmonary insufficiency was higher in the root replacement group, while autograft regurgitation was rare and similar between groups.
• Homograft peak systolic gradients were higher, and indexed EOA lower, in the root replacement group.

Conclusions:

• The root replacement technique offers advantages in aortic EOA and annulus diameter.
• Autograft regurgitation was rare and not technique-dependent.
• Long-term durability of both techniques requires further investigation, with potential challenges in root dimensions for the free-root technique.