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J Thorac Cardiovasc Surg 1998;115:1091-1095
© 1998 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Ten years of experience with the modified Ross procedure

From the Division of Cardiac Surgery, Beth Israel Medical Center, New York City, N.Y.

Received for publication July 8, 1997. Revisions requested Sept. 3, 1997; revisions received Oct. 10, 1997. Accepted for publication Dec. 3, 1997. Address for reprints: Paul Stelzer, MD, Division of Cardiac Surgery, Beth Israel Medical Center, 317 East 17th St., 11th Floor, New York City, NY 10003.

Abstract

Background: To assess the full root modification of the Ross procedure, we examined operative and long-term results.
Methods: We retrospectively reviewed 145 patients (118 men and 27 women) operated on from March 1987 through April 1997. Ages ranged from 17 to 68 years. Primary diagnosis was aortic stenosis in 43 patients (29.6%) and aortic regurgitation in 62 patients (42.8%). There was mixed disease (stenosis and regurgitation) in 40 patients (29.6%) of whom the vast majority had predominant stenosis.
Results: Early death was 7 of 145 patients (4.8%). Twelve patients had 14 significant complications (8.5%). There were four late deaths. Overall patient survival is 90.5% ± 3.1% at 5 years and 84.5% ± 14.1% at 7 years. Endocarditis occurred in three patients—two on the autograft and one on the pulmonary homograft. Three patients had cerebrovascular accidents. In 5 of 132 patients (3.8%) reoperations were required on the autograft. Freedom from autograft reoperation was 93.9% ± 3.1% at 5 years and 88.6% ± 6.4% at 7 years. Echocardiographic follow-up reveals more than mild aortic regurgitation in only nine patients, including the five patients in whom reoperations were required. Seven of 11 patients with active endocarditis at the time of the operation had adverse outcomes.
Conclusions: Ten years' experience with the modified Ross procedure has shown excellent results with regard to short- and long-term morbidity and death. It is the procedure of choice for young patients who need aortic valve replacement but should be used with caution in the setting of active endocarditis.

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