Ross procedure in congenital patients: results and left ventricular function

From April 1990 to August 1995, 121 patients (median age 42 years) underwent aortic valve replacement with allografts (69 patients) or autografts (52 patients). In this latter group, 24 Ross procedures have been performed in congenital patients since November 1991 (median age 10 years, range five months to 27 years): aortic incompetence (n = 17), isolated aortic stenosis (n = 5), small stenotic prosthesis (n = 2). Transthoracic echocardiography was obtained preoperatively in all patients and serially after surgery with the aim of measuring aortic and pulmonary annuli and evaluate gradients and incompetence and to study the left ventricular function. Intraoperative transoesophageal echocardiography was routinely used. Complete root replacement was performed in all patients.

One patient died in the early postoperative period (4%). There was no late death. All survivors remained in NYHA class I and were free of complications and medications. No gradient nor any significant aortic incompetence could be demonstrated. In 17 patients with predominant aortic incompetence before surgery, the left ventricular function was followed prospectively, end-diastolic left ventricular dimensions diminished drastically from 2 +/- 3.4 S.D. above normal to -0.63 +/- 2.4 S.D. at one week postoperatively (day 10) to reach a normal value one to three months after surgery. Left ventricular mass remained abnormal at day 10 (from 4.7 +/- 3.3 S.D. to 5.3 +/- 3.8 S.D.) and diminished more progressively to reach a normal value (0.14 +/- 1.4 S.D.) at three months. This resulted in a significant decrease of end-systolic wall stress (-3.6 +/- 2.1 S.D.) and in a hyperdynamic function in the immediate postoperative days except in two patients. These two patients were characterized preoperatively by more severely dilated left ventricle (end diastolic dimension 5.3 +/- 0.03 versus 1.6 +/- 3 S.D.) with decreased left ventricular wall thickness (1.19 +/- 0.7 versus 3.44 +/- 1.9 S.D.), decreased ratio between end diastolic wall thickness and end diastolic dimension (0.14 +/- 0.06 versus 0.2 +/- 0.06) and a decreased velocity of shortening. Unlike the other 15 patients, the left ventricular function did not recover completely at mid term follow-up in those two patients.

The Ross operation is a safe procedure and allows us to suppress completely the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function in most patients.