Ross procedure and left ventricular mass regression.
BACKGROUND
Return of left ventricular mass to normal is considered to be a favorable result of aortic valve replacement. The Ross procedure provides near normal hemodynamics and thus allows studies of left ventricular (LV) reverse remodeling. LV mass regression may be influenced by surgical technique (subcoronary [SC] versus root replacement [RR]).


RESULTS
Data from the German Ross Registry were analyzed. A total of 646 patients (mean age: 43.6+/-12.7 years, range: 16 to 71 years; SC technique n=295, RR technique n=351) underwent a Ross procedure in 7 participating centers from 1990 to 2004. The patients underwent preoperative and postoperative echocardiographic evaluations. Mean follow-up time was 3.5+/-2.5 years (range 0.12 to 13.7 years). Follow-up completeness was 97%. The LV mass index (LVMI) decreased significantly during follow-up in both groups (SC: 209+/-53 preoperatively to 154+/-48 at 1-year follow-up, [P<0.01 versus preoperative values] to 149+/-51 g/m2 at 2-year follow-up, [P=NS 1-year versus 2-year follow-up] versus RR: from 195+/-56 preoperatively to 144+/-51 at 1-year follow-up [P<0.01 versus preoperative values] to 140+/-49 g/m2 [P=NS 1-year versus 2-year follow-up]). LVMI regression remained stagnant 1 year after the Ross procedure in most patients in both groups. On the basis of multivariate analysis, predictors for incomplete LVMI regression after the autograft procedure were high preoperative LVMI, smoking, and uncontrolled diastolic hypertension.


CONCLUSIONS
At mid-term echocardiographic follow-up, patients of both groups had favorable autograft hemodynamics. Risk factors for incomplete postoperative LVMI regression in our study were smoking and persistent diastolic hypertension. This emphasizes the importance of cessation of smoking and treatment of arterial hypertension, even in younger patients, after corrected aortic valve disease.
Duebener
Lennart F
LF
Department of Cardiac Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Germany.
Stierle
Ulrich
U
Erasmi
Armin
A
Bechtel
Matthias F
MF
Zurakowski
David
D
Böhm
Jürgen O
JO
Botha
Cornelius A
CA
Hemmer
Wolfgang
W
Rein
Joachim-Gerd
JG
Sievers
Hans-H
HH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011093:Polyethylene Terephthalates; D019736:Prostheses and Implants; D011664:Pulmonary Valve / Q000637:transplantation*; D012042:Registries / Q000706:statistics & numerical data; D013536:Suture Techniques; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic; D014463:Ultrasonography; D020257:Ventricular Remodeling
D011093:Polyethylene Terephthalates