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

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.

Abbreviations and Acronyms: AI, aortic insufficiency, CI, confidence interval, HR, hazard ratio