Ross operation in the adult: long-term outcomes after root replacement and inclusion techniques.
BACKGROUND
Dilatation of the pulmonary autograft is a major concern after root replacement for the Ross operation. The inclusion technique would avoid this drawback, but few data are available on the long-term results of this technique. We retrospectively analyze long-term results of both techniques.


METHODS
Of 218 patients undergoing the Ross operation between 1991 and 2006, 148 (68%) had root replacement and 70 (32%) underwent the inclusion technique. The mean age of the patients was 40 +/- 10 years (range, 16 to 64). Mean follow-up was 94 +/- 44 months (range, 13 to 196). Echocardiographic controls were available in 197 patients. Proximal aorta dilatation was defined as diameter > 40 mm.


RESULTS
In the root and inclusion groups, 10-year overall survival was 94% +/- 4% and 97% +/- 4%, respectively. Freedom from autograft reoperation was 81% +/- 10% and 84% +/- 13%, respectively. Main cause of reoperation was autograft dilatation in the root group (13 of 16) and valve prolapse in the inclusion group (5 of 6). Freedom from proximal aorta dilatation was 57% +/- 12% and 80% +/- 15%, respectively. In the root group, dilatations (n = 48) affected systematically the autograft sinuses or sinotubular junction, whereas in the inclusion group, dilatations (n = 10) affected principally the ascending aorta (8 of 10). Freedom from severe autograft regurgitation was 86% +/- 9% and 83% +/- 13%, respectively. Root technique, follow-up length, and preoperative aortic valve regurgitation were predictors of proximal aorta dilatation.


CONCLUSIONS
In the long term, both techniques showed excellent survival and similar rates of autograft failure. For root replacement, autograft dilatation was the main cause of failure. For the inclusion technique, the autograft, but not the ascending aorta, was protected against dilatation and autograft valve prolapse was the main cause of failure.
de Kerchove
Laurent
L
Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. laurent.dekerchove@uclouvain.be
Rubay
Jean
J
Pasquet
Agnès
A
Poncelet
Alain
A
Ovaert
Caroline
C
Pirotte
Manuel
M
Buche
Michel
M
D'Hoore
William
W
Noirhomme
Philippe
P
El Khoury
Gebrine
G
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006349:Heart Valve Diseases / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult