The Ross operation in the treatment of native and prosthetic aortic valve endocarditis

Bacterial endocarditis of the native or prosthetic aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when invasion of perivalvular tissue occurs. The currently recommended treatment for these advanced infections, in addition to thorough debridement, is aortic valve or root replacement with a homograft, although it appears that equally good results can be achieved with prosthetic valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of non-infective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. This paper describes successful use of the Ross operation as total root replacement in six young patients between 10 and 32 years of age with aortic valve endocarditis. Three of the patients had active endocarditis and five patients had advanced disease, i.e. endocarditis with perivalvular tissue invasion and destruction. Follow up extending to 18 months continues to show excellent results with no mortality and no re-infection. We conclude that the Ross operation as total root replacement may be the best procedure for young patients with aortic valve endocarditis. The pulmonary autograft appears to be technically particularly well-suited, has growth potential, excellent hemodynamics, and a low risk of re-infection, thrombosis, and embolic complications without anticoagulation. Based on the long term results of the Ross operation in non-infected patients, excellent long term results are expected in this group as well.