Ross procedure in rheumatic aortic valve disease.
OBJECTIVE
To assess the results of aortic valve replacement with the pulmonary autograft in patients with rheumatic heart disease.


METHODS
From October 1993 through September 2003, 81 rheumatic patients with aortic valve disease, mean age 29.5+/-11.9 years (11-56 years) underwent, the Ross procedure with root replacement technique. Forty patients were 30 years of age or below (young rheumatics). Associated procedures included mitral valve repair (n=19), open mitral commissurotomy (n=15), tricuspid valve repair (n=2), and homograft mitral valve replacement (n=2).


RESULTS
Early mortality was 7.4% (six patients). Mean follow-up was 92.3+/-40.9 months (7-132 months, median 109 months). Sixty of the 73 patients whose follow-up was available (82%) had no significant aortic regurgitation. Re-operation was required in seven (8.4%) patients for autograft dysfunction with failed mitral valve repair (n=3), autograft dysfunction alone (n=2) and failed mitral valve repair alone (n=2). No re-operations were required for the pulmonary homograft. There were six (7.5%) late deaths. Actuarial survival and re-operation-free survival at 109 months were 84.5+/-4.1% and 90.5+/-3.7%, respectively. Freedom from significant aortic stenosis or regurgitation was 78.4+/-5.2% and event-free survival was 64.6+/-5.8%. When compared to rheumatics above 30 years of age, the relative risk of autograft dysfunction was high in the young rheumatics.


CONCLUSIONS
The Ross procedure is not suitable for young patients with rheumatic heart disease. However, it provides acceptable mid-term results in carefully selected older (>30 years) patients with isolated rheumatic aortic valve disease.
Sampath Kumar
Arkalgud
A
Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110-029, India. asampath_kumar@hotmail.com
Talwar
Sachin
S
Saxena
Anita
A
Singh
Rajvir
R
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002648:Child; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D016016:Proportional Hazards Models; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000637:transplantation*; D012008:Recurrence; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery