Objective Dilatation of the pulmonary autograft root exposed to systemic pressure is still the crucial problem in the long-term follow-up after Ross operation. We assessed the prevalence, risk factors, and clinical consequences of late autograft dilatation. Methods History of 86 pts (mean age, 9,6 ± 2,7 years) who underwent Ross or Konno-Ross surgery between 1995-2008 were reviewed. There were 45 pts below 15 years of age. Autograft annulus size, autograft sinus diameter and valve insufficiency (AI) were assessed using transthoracic echocardiography one week after procedure, 6 months and then annually after operation and were compared with normal valves values. V/s index (autograft annulus to sinus diameter), Z-score for autograft annulus and Z-score rate of change per year (g/y) was calculated. To verify these measurements multi-slice CT was completed in selected patients.
Results End-points of the study were freedom from autograft dilatation, from moderate or severe autograft regurgitation and from reoperation. Late autograft dilatation was identified in 27 (31%) patients and regurgitation in 6 (7%). Freedom from dilatation , from regurgitation and from reoperation (mechanical valve -1pt) was calculated. Autograft root diameters were compared to normal values (Z-score) referred to annulus, sinus of Valsalva and sinotubular junction. Older age was identified as predictive for autograft dilatation. Conclusions Autograft dilatation was revealed more frequently in patients who underwent Ross procedure above 7 yrs of age but it wasn’t associated with increased autograft valve insufficiency. Higher Z-score in younger patients was a result of physiological discrepancy in diameters between pulmonary and aortic valves.