Pulmonary autograft aortic valve replacement: long-term results

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Pediatric Cardiac Surgery

Background:

• Homograft aortic valves previously showed progressive degeneration.
• The Ross procedure was developed as an alternative to homograft valves.
• This study evaluates a large series of Ross procedures performed over decades.

Purpose of the Study:

• To assess the long-term outcomes and durability of the Ross procedure.
• To evaluate the safety and efficacy of using autologous pulmonary valves for aortic valve replacement.
• To determine the potential for growth and long-term viability of the pulmonary autograft in pediatric patients.

Main Methods:

• Retrospective analysis of 339 aortic valve replacements using the Ross procedure.
• Data collection on hospital mortality, late mortality, reoperation, and complications.
• Long-term follow-up including actuarial survival and freedom from events.
• Examination of explanted valves for signs of degeneration and tissue viability.

Main Results:

• Overall hospital mortality was 7.4%, with a significant decrease after 1976.
• Actuarial survival was 80% at 20 years, with 85% freedom from reoperation.
• No thromboembolic events were reported without anticoagulant use.
• Bacterial endocarditis occurred in 11 patients; 33 patients required reoperation.
• Explanted valves showed viable tissue without calcification or degeneration; evidence of growth in children was observed.

Conclusions:

• The Ross procedure demonstrates excellent long-term durability and survival, with a low risk of degeneration.
• It offers a potentially permanent aortic valve replacement option for infants, children, and young adults.
• The absence of anticoagulation and potential for growth make it a favorable choice for pediatric cardiac surgery.