The Ross Procedure: Is it the Ideal Operation for the Young with Aortic Valve Disease?
Abstract
Background: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and normalize left ventricular function. This possibly affects long-term prognosis after aortic valve replacement.
Objective: Assessment of hemodynamic performance of pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure.
Methods: Between May 1995 and March 1996, 45 patients with mean age of 27.1 years underwent a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to evaluate the hemodynamic performance of auto- and homografts, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were submitted to dobutamine stress echocardiography to study the hemodynamic performance of auto- and homografts during exercise.
Results: Hospital mortality was 6%. After a mean follow-up of 12.8 months (1–23 months), there was one late sudden death. No valve-related event was observed during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with an average mean gradient of 1.8 ± 0.6 mmHg and an average maximum instantaneous gradient of 2.9 ± 0.9 mmHg. Valvular insufficiency was insignificant. Even during exercise, gradients did not increase significantly with an average mean gradient of 4.3 ± 2.5 mmHg and an average maximum gradient of 10.4± 6.1 mmHg. Homografts used for right ventricular reconstruction showed excellent immediate hemodynamic performance. However, at late follow-up an increase in flow speed was observed with an average of mean gradient of 10 ± 7.1 mmHg at rest and 26 ± 13.3 mmHg during exercise. Left ventricular mass index dropped from 168 ± 46 g/m2 preoperatively to 115 ± 32 g/m2 six months after the operation. Left ventricular function was normal at rest and during exercise in the majority of patients.
Conclusion: Given the normal hemodynamic function of pulmonary autografts, the reduction of ventricular mass and normalization of left ventricular function, in addition to the excellent late follow-up of the patients, the Ross procedure is considered the operation of choice for young patients requiring aortic valve replacement.
