Aortic valve replacement with the pulmonary autograft: mid-term results.

Background: The purpose of this study is to assess the mid-term results of aortic valve replacement with the pulmonary autograft.

Methods: From October 1993 through September 2003, 153 patients with aortic valve disease (81 rheumatic and 72 non-rheumatic), with a mean age of 28 +/- 14.2 years underwent the Ross procedure with root replacement technique and right ventricular outflow tract reconstruction using a homograft. Associated procedures included mitral valve repair (n = 19), open mitral commissurotomy (n = 15), tricuspid valve repair (n = 2), homograft mitral valve replacement (n = 2), and subaortic membrane resection (n = 1).

Results: Early mortality was 6.5% (10 patients). Mean follow-up was 77 +/- 42 months (range, 7 to 132 months; median, 90 months). One hundred, twenty-one survivors (84.6%) had no significant aortic regurgitation. Reoperation was required in 10 patients for autograft dysfunction alone (n = 3), infective endocarditis (n = 2), autograft dysfunction with failed mitral valve repair (n = 3), and failed mitral valve repair alone (n = 2). No reoperations were required for the pulmonary homograft. There were 8 late deaths. Actuarial and reoperation-free survival at 90 months were 91.% +/- 3.5%, 95.3% +/- 2.7%, in non-rheumatics and 86.1 +/- 3.9%, 90.5 +/- 3.7% in rheumatics, respectively. Freedom from significant aortic stenosis or regurgitation was 91.5 +/- 2.8% in non-rheumatics and 80.6 +/- 4.8% in rheumatics. Event-free survival was 86.2 +/- 4.9% in non-rheumatics and only 68.9 +/- 5.3% in rheumatics.

Conclusions: The Ross procedure is not recommended for young patients (< 30 years) with rheumatic heart disease. It provides satisfactory hemodynamic and clinical results in properly selected patients. Important autograft dilatation was not observed in our patients.