4113Long-term evaluation of the Ross procedure: clinical and echocardiographic follow-up at 20 years

Abstract

Background: Ross surgery is a technically complex procedure used in children and young adults requiring replacement of the aortic valve (AV), in which the native pulmonary valve is switched to the aortic position - autograft (Ag) - and a cryopreserved homograft (Hg) is implanted in a pulmonary position. This procedure offers some advantages compared to mechanical prostheses: absence of anticoagulation, low risk of endocarditis and thrombogenicity and equivalent survival. However, the durability and incidence of re-operation remains a major concern. Aim: The aim was to evaluate the long-term clinical and echocardiographic results of Ross procedure. Methods: Single-centre retrospective study that included a cohort of 52 adult patients: mean age at surgery of 44±12 years old, 58% men, 33% rheumatic disease and 29% congenital aortic disease. Clinical endpoints included global mortality and the need for valve reoperation due to failure of one graft. Echocardiographic follow-up included the presence of the aortic Ag or pulmonary Hg deterioration by at least moderate regurgitation or stenosis with a mean gradient≥20mmHg. The median clinical follow-up was 20±3 years (1040 patients/year) and the echocardiographic follow-up was 19±4 years. Results: The indication for surgery was in 40% the predominance of AV stenosis, in 21% prevalence of regurgitation and 31% mixed aortic disease. The subcoronary technique was the most used in 85% of the cases. The median time of cardiopulmonary bypass was 151±34 min and the median time of hospitalization was 8±3 days. Concomitant mitral surgery was performed in 21% of patients. During the follow-up, the overall survival was 81% and the free survival of graft re-operation was 83% - Figure 1. Of the patients who were not re-operated and were alive at the end of follow-up, 11 patients (31%) had moderate AV regurgitation; 6 (15%) moderate pulmonary regurgitation and only 1 patient with moderate pulmonary stenosis - Figure 1. Conclusion: In the long-term follow-up of the Ross procedure, the subcoronary approach proved to have excellent clinical and hemodynamic results with low rates of reoperation. Moderate aortic regurgitation was a frequent and concordant finding amongst other studies with no clinically significant impact on the mean follow-up and at the 20 years follow up mark. (Figure Presented).