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Eur J Cardiothorac Surg 2006;29:156-161
© 2006 Elsevier Science NL

Ross procedure in rheumatic aortic valve disease

^a Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
^b Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Received 6 October 2005; received in revised form 15 November 2005; accepted 18 November 2005.

^_* Corresponding author: Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. Tel.: +91 11 26588889; fax: +91 11 26588889. (Email: asampath_kumar{at}hotmail.com).

Objective: To assess the results of aortic valve replacement with the pulmonary autograft in patients with rheumatic heart disease. Methods: From October 1993 through September 2003, 81 rheumatic patients with aortic valve disease, mean age 29.5 ± 11.9 years (11–56 years) underwent, the Ross procedure with root replacement technique. Forty patients were 30 years of age or below (young rheumatics). Associated procedures included mitral valve repair (n = 19), open mitral commissurotomy (n = 15), tricuspid valve repair (n = 2), and homograft mitral valve replacement (n = 2). Results: Early mortality was 7.4% (six patients). Mean follow-up was 92.3 ± 40.9 months (7–132 months, median 109 months). Sixty of the 73 patients whose follow-up was available (82%) had no significant aortic regurgitation. Re-operation was required in seven (8.4%) patients for autograft dysfunction with failed mitral valve repair (n = 3), autograft dysfunction alone (n = 2) and failed mitral valve repair alone (n = 2). No re-operations were required for the pulmonary homograft. There were six (7.5%) late deaths. Actuarial survival and re-operation-free survival at 109 months were 84.5 ± 4.1% and 90.5 ± 3.7%, respectively. Freedom from significant aortic stenosis or regurgitation was 78.4 ± 5.2% and event-free survival was 64.6 ± 5.8%. When compared to rheumatics above 30 years of age, the relative risk of autograft dysfunction was high in the young rheumatics. Conclusion: The Ross procedure is not suitable for young patients with rheumatic heart disease. However, it provides acceptable mid-term results in carefully selected older (>30 years) patients with isolated rheumatic aortic valve disease.

Key Words: Ross operation • Rheumatic heart disease • Aortic valve replacement • Autograft

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