Background: The Ross procedure in infants/children is generally accepted, while in adults it remains controversial. We examined our adult experience for clinical and operative factors that predict autograft reoperation.
Methods: Prospectively collected data of 160 consecutive adults undergoing a Ross procedure by a single surgeon from July 1994 through June 2008 were reviewed. Clinical follow-up was obtained in 160 of 160 (100%) and echocardiogram in 150 of 152 (98.7%) survivors. Multivariate proportional hazards analysis was employed to determine risk factors for autograft reoperation.
Results: Mean age was 42.0±11.1 years and 73.1% were male. Presenting pathology was aortic insufficiency (AI) in 93 (58.1%) and aortic stenosis (AS) in 67 (41.9%). Bicuspid aortic valves accounted for 91% of AS and 85% of AI patients. Annuloplasty was required in 49 of 93 (52.7%) patients with AI and 12 of 67 (17.9%) patients with AS (p<0.001). There were 3 operative mortalities (1.87%) with 2 late cardiac related deaths (1.3%). Kaplan-Meier survival was 92.9±0.03% at 7.5 years. Fifteen patients (9.4%) required reoperation on the autograft root; 14 of 15 (93.3%) had AI. The time to aortic valve reoperation significantly diverged at 7.5 years; patients with AI required more reoperations. Factors predicting increased risk of autograft reoperation included female gender (hazard ratio [HR]=7.7; 95% confidence interval [CI] 1.3 to 46.6), aortic dilatation (HR=6.3; 95% CI 1.3 to 33.2), a 3-cusp valve (HR=8.1; 95% CI 1.3 to 53.3) and annuloplasty (HR=7.8; 95% CI 1.2 to 52.0).
Conclusions: The Ross procedure in adults provides excellent freedom from autograft failure in patients operated for AS. Other treatment alternatives should be strongly considered in adults presenting primarily with aortic insufficiency.
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