The Ross operation for aortic valve disease: previous sternotomy results in improved long-term outcome.
OBJECTIVE
Progressive pulmonary autograft dilatation and failure following a Ross operation continues to be of major concern. It is hypothesized that the pulmonary autograft may perform better over the longer follow up period if the Ross operation is performed as a reoperation rather than a primary operation. The basis for this hypothesis is that the epicardial and mediastinal fibrosis encountered at reoperation may inadvertently provide additional support for the pulmonary autograft during the follow up period.


METHODS
To test this hypothesis, 281 patients (mean age 24 +/- 9 years) who underwent a Ross operation over a 16-year period were retrospectively analyzed. The patient population was divided into two subgroups in whom the Ross operation was performed: (i) as the first cardiac operation, through a sternotomy incision (primary-Ross; n = 180); and (ii) after the patient had undergone a previous sternotomy (prior-sternotomy; n = 101). A recent follow up examination was achieved in 93% of patients.


RESULTS
Early and overall mortality was 2.1% and 6.4%, respectively, and there was no significant difference between the subgroups. At 12-year follow up, freedom from reoperation on the autograft, or valve-related death was 87 +/- 6% versus 71 +/- 9% in favor of the prior-sternotomy subgroup (p = 0.06). At 12-year follow up, freedom from valve-related death, or reoperation on the pulmonary autograft, or severe aortic regurgitation was 87 +/- 5% versus 71 +/- 7% (p = 0.03) in favor of the prior-sternotomy subgroup.


CONCLUSIONS
The results of a preliminary analysis suggest that additional benefit is accrued when the Ross operation is performed during re-sternotomy. This should encourage surgeons to attempt repair of the aortic valve during the initial surgery, with the knowledge that - if needed - the Ross operation can be performed safely at later surgery, and with possible additional benefit to the patient during the follow up period.
Knott-Craig
Christopher J
CJ
University of Oklahoma Health Sciences Center, Department of Thoracic and Cardiovascular Surgery, Oklahoma, USA. ckc@uab.edu
Goldberg
Steven P
SP
Pastuszko
Peter
P
Peyton
Marvin D
MD
Kirklin
James K
JK
D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome