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J Thorac Cardiovasc Surg 2010;139:68-75
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

When is the Ross operation a good option to treat aortic valve disease?

Cardiac Program of the Peter Munk Cardiac Centre at Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada

Received for publication April 29, 2009; revisions received July 12, 2009; accepted for publication September 30, 2009.

^_* Address for reprints: Tirone E. David, MD, 200 Elizabeth St 4N457, Toronto, Ontario M5G 2C4, Canada. (Email: tirone.david{at}uhn.on.ca).

Objective: We sought to identify suitable patients for the Ross operation.

Methods: A cohort of 212 patients (mean age, 34 ± 9 years; 66% men; 82% with congenital aortic valve disease) underwent the Ross operation and was prospectively followed with clinical evaluations and echocardiographic analysis for 3.1 to 18 years (mean, 10.1 ± 4.2 years). In addition to longitudinal outcomes determined by means of Kaplan–Meier analysis, Cox regression analysis was used to identify predictors of valve failure.

Results: There were 1 operative and 4 late deaths, none of which were valve related. Survival at 15 years was 96.6% ± 1.5% and similar to that seen in the general population matched for age and sex. There were 20 reoperations: 13 in the pulmonary autograft, 3 in the pulmonary homograft, and 4 others. Freedom from reoperation in the pulmonary autograft at 15 years was 92.1% ± 2.3%. Aortic insufficiency was the only independent predictor of reoperation. Freedom from moderate or severe aortic insufficiency at 15 years was 89.7%, and greater than mild aortic insufficiency was 63.2%. Male sex, aortic/pulmonary annular mismatch, aortic annulus of 27 mm or larger, and preoperative aortic insufficiency were associated with higher risk of late aortic insufficiency by means of log-rank analysis. Cox regression analysis identified male sex as the only independent predictor of postoperative aortic insufficiency. Freedom from moderate or severe pulmonary insufficiency, peak gradient of 40 mm Hg or greater, or both at 15 years was 70.8% ± 6.8%, and event-free survival was 81% ± 3.7%.

Conclusions: The Ross operation provided suboptimal results in male patients with aortic insufficiency. The best outcomes were in female patients, those with aortic stenosis, and those with an aortic annulus of less than 27 mm in diameter.

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