title: Hemodynamic performance following the Ross operation: comparison of two different techniques.
abstract: OBJECTIVE
  The Ross operation as aortic valve replacement has undergone technical evolution. Originally described as a subcoronary implant, the full-root replacement technique is now more common worldwide. It remains unclear which of the two techniques has the better results. Hence, the hemodynamic performances of the two implantation methods, as applied by two experienced centers, were compared as part of the German Ross Registry.
  
  
  METHODS
  In total, 132 (Group 1, root replacement, mean age 40 +/- 14 years) and 249 (Group 2, subcoronary implant, mean age 48 +/- 14 years) consecutively operated patients were compared clinically and echocardiographically. Data were analyzed focusing on pulmonary autograft and homograft function at mid-term (2.78 +/- 1.89 versus 2.26 +/- 2.11 years).
  
  
  RESULTS
  Echocardiography revealed autograft peak systolic gradients of 5.0 +/- 2.7 mmHg for Group 1 and 6.7 +/- 3.7 mmHg for Group 2 (p < 0.05), and an indexed effective orifice area (EOA) of 1.98 +/- 0.57 cm2/m2 and 1.64 +/- 0.43 cm2/m2 (p < 0.05), respectively. Homograft peak systolic gradients were 15.6 +/- 9.0 mmHg and 11.7 +/- 6.8 mmHg for Groups 1 and 2 (p < 0.05) respectively, and the indexed EOA with regard to the homograft was 1.08 +/- 0.49 cm2/m2 and 1.26 +/- 0.50 cm2/m2 (p < 0.05). Autograft insufficiency grade > I was present in 1.5% (2/132) of Group 1 and 2.8% (7/249) of Group 2 patients. Pulmonary insufficiency grade > I was 17.4% (23/132) for Group 1 and 4.8% (12/249) for Group 2 (p < 0.05).
  
  
  CONCLUSIONS
  Although both groups enjoyed excellent hemodynamics in the mid-term, the root replacement technique had the advantage of larger annulus diameters and greater aortic EOA. Clinically relevant autograft regurgitation in both groups was gratifyingly rare, and seemed to be independent of surgical technique. Long-term durability of the more demanding subcoronary technique versus the problems of larger dimensions of the sinus of Valsalva and sinotubular junction in the free-root technique, remains to be proven. Apparent differences in pulmonary homograft hemodynamics can most likely be explained by surgical differences, younger patients in Group 1, and by homograft variation.
authors.affiliation: Sana Herzchirurgische Klinik Stuttgart, Stuttgart, Germany. joboehm@z.zgs.de
authors.forename: Jürgen O
authors.initials: JO
authors.lastname: Böhm
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Botha
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hemmer
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmidtke
authors.forename: J F Matthias
authors.initials: JF
authors.lastname: Bechtel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Joachim-Gerd
authors.initials: JG
authors.lastname: Rein
authors.forename: Hans H
authors.initials: HH
authors.lastname: Sievers
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001023:Aortic Valve Prolapse / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome