Objectives. Autograft valve and root pathology is the leading cause of Ross procedure failure. In order to define feasibility and outcome of autograft valve/root repair at reoperation, a 14-year clinical experience was analyzed.
Methods: One-hundred-twenty-five patients surviving an average of 7.0±1.9 years (range 0.5-14) after the Ross procedure underwent cross-sectional clinical and echocardiographic examination. End-points of the study were freedom from autograft reoperation, from root/valve replacement, functional outcome after valve/root repair.
Results. Seventeen (14%) patients underwent 21 cardiac procedures at an average of 6.0±3.1 years (range 0.08-14.3 years) after Ross operation. Eleven had undergone root replacement, 5 inclusion cylinder and 1 subcoronary grafting. Among these, 11 (65%) required root and 6 valve reoperation. Surgery consisted in valve/root repair in 12 and AVR in 5, with no hospital mortality. Freedom from any cardiac reoperation was 78±5% at 14 years. During follow-up 4.9±1.9 years (range 0.4-10.2 years), 4/12 patients having autograft valve/root repair required AVR, while 8 present mild autograft valve inusfficiency or less. Actuarial freedom from autograft valve replacement was 86±4% at 14 years. Predictors of reoperation were older age at Ross (p=0.04), use of root technique (p=0.001) and length of follow-up (p=0.02). Failure of valve/root repair was associated with isolated valve pathology (p=0.001), severity of autograft insufficiency (p=0.01) and earlier reoperation (p=0.002).
Conclusions. Autograft reoperation with pulmonary valve repair is feasible in half of patients with Ross failure. Coexistent root pathology and absence of severe valve dysfunction are predictive of successful and durable repair.