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The Ross operation shows excellent survival for aortic valve replacement (AVR). However, a concerning increase in reoperation rates due to autograft dilatation requires careful long-term patient monitoring.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Pediatric Cardiac Surgery

Background:

  • The Ross operation, using a pulmonary autograft for aortic valve replacement (AVR), is preferred for children and selected adults.
  • Concerns exist regarding the long-term durability of autografts and allografts.
  • This study reports 13-year outcomes of a prospective pulmonary autograft cohort.

Purpose of the Study:

  • To evaluate the 13-year results of the Ross operation using a pulmonary autograft.
  • To assess survival rates and reoperation trends in a large patient cohort.
  • To identify risk factors associated with autograft failure.

Main Methods:

  • Prospective cohort study of 146 patients undergoing AVR with a pulmonary autograft (1988-2005).
  • Data collection included hospital mortality, overall survival, and reoperation rates.
  • Statistical analysis focused on freedom from reoperation and risk factor identification.

Main Results:

  • 13-year survival was 94% +/- 2%.
  • 22 patients (15%) required autograft reoperation for neo-aortic root dilatation.
  • Freedom from autograft reoperation at 13 years was 69% +/- 7%; risk factors included prior AVR and adult age.

Conclusions:

  • The Ross operation offers excellent survival but shows a significant increase in reoperation rates over time.
  • Progressive autograft dilatation necessitates vigilant follow-up in the second decade post-surgery.
  • Careful monitoring is crucial for patients who have undergone AVR with a pulmonary autograft.