title: Autograft failure after the Ross operation in a rheumatic population: pre- and postoperative echocardiographic observations.
abstract: OBJECTIVE
  Between January 1990 and July 1995, 108 patients underwent the Ross operation at our hospital. Most patients (90%) had severe aortic regurgitation (AR) in the setting of rheumatic heart disease. Although there have been no perioperative or late cardiac deaths, 12 patients (11%) developed severe AR requiring reoperation.
  
  
  METHODS
  We performed an extensive and mostly retrospective analysis of echocardiographic data on all patients. Preoperative data were analyzed for age, sex, body surface area (BSA), size and comparison of the left and right ventricular outflow tracts (LVOT, RVOT), left ventricular (LV) size and function, and the presence of pulmonary regurgitation (PR) and concomitant mitral regurgitation (MR). Follow up data were analyzed for the presence, time of onset, evolution and severity of AR, characteristics of the AR jet, anatomic and functional aspects of the aortic root and valve, and evolution of LVOT diameter and LV size and function.
  
  
  RESULTS
  Patients with autograft failure were younger with smaller BSA, larger indexed size of LVOT, RVOT and LV, and significantly more had concomitant severe MR. Postoperatively they had larger and increasing LVOT size. Trivial or mild AR was common and seen in almost all patients, as was a minimal degree of preoperative PR. Severe AR developed mostly after the first year of follow up, and reoperation was performed within three years in 11/12 patients. In nine patients cusp dilatation and prolapse (most frequently of the posterior cusp) was the cause of the AR, and rheumatic activity in three. Reoperation was not associated with mortality.
  
  
  CONCLUSIONS
  In our population autograft failure seems to be related to age, BSA and (indexed) LVOT, RVOT and LV size, but only the presence of significant concomitant mitral regurgitation before surgery was identified as a predictor for reoperation. Prolapse of one or more cusps were the cause of the AR in most patients. The graft is sensitive for recurrent rheumatic activity.
authors.affiliation: Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: F A
authors.initials: FA
authors.lastname: Pieters
authors.forename: Z
authors.initials: Z
authors.lastname: al-Halees
authors.forename: F E
authors.initials: FE
authors.lastname: Zwaan
authors.forename: L
authors.initials: L
authors.lastname: Hatle
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D011664:Pulmonary Valve / Q000637:transplantation*; D012214:Rheumatic Heart Disease / Q000150:complications* / Q000000981:diagnostic imaging; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016277:Ventricular Function, Left