The Ross operation: do native aortic, native pulmonary, and homograft pulmonary valve size and form differences influence results?

Background: The pulmonary autograft approaches the ideal aortic valve substitute but numerous technical modifications are debated. The valves involved often differ in diameter and shape of the recipient annulus. We previously reported simplified surgical rules and early results of 52 patients and here we extend the report to 76 patients and analyze the mid-term results with respect to valve mismatch.

Methods: We studied the influence of geometric discrepancies. Valve regurgitation and gradient are compared for size discrepancies up to or more than 3 mm between recipient annulus and pulmonary autograft. The normal tricuspid recipient aortic annulus is compared with the flat circular redo-prosthetic or bicuspid annulus. Patients with plication of the aortic annulus and remodeling of the distal aorta are reviewed, and lastly donor homograft to pulmonary autograft discrepancies up to and more than 3 mm are compared.

Results: The results were comparable in all groups and no significant differences were observed.

Conclusion: The pulmonary autograft operation may be simplified, with good results at the least in the first year despite operative tailoring due to valve discrepancies.