Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY37. When Is the Ross Procedure a Good Option to Treat Aortic ValveDisease?Tirone E. David, * Anna Woo, Susan Armstrong, Manjula MagantiCardiovascular Surgery, Toronto General Hospital, Toronto, ON, CanadaInvited Discussant: Lawrence H. CohnOBJECTIVE: To identify suitable patients for the Ross procedure.METHODS: A cohort of 212 patients (mean age 34 ± 9 years, 66% men, 82% withbicuspid aortic valve disease = BAV) had the Ross procedure and was prospectivelyfollowed with clinical evaluations and echocardiography from 1 to 19 years, meanof 9.5 ± 3.7 years. In addition to longitudinal outcomes by Kaplan-Meier analysis,numerous perioperative variables were entered into a multivariable analysis toidentify predictors of failure of the procedure.RESULTS: There were one operative and four late deaths, none valve-related. Thesurvival at 15 years was 96.6 ± 1.5% and identical to the general populationmatched for age and gender. There were 18 reoperations: 11 in the pulmonaryautograft, 3 in the pulmonary homograft and 4 others. At 15 years the freedomfrom reoperation in the pulmonary autograft was 93.0 ± 2.2%, and the freedomfrom moderate or severe aortic insufficiency (AI) was 90 ± 3%. Cox regressionanalysis identified preoperative AI due to BAV as independent predictors of AI >2+ (H.R. = 3.9; 95% C.I. 2.4–5.4). The technique of implantation of the autografthad no effect on the development of late AI > 2+. There was no reoperation due toAI in patients with aortic stenosis. At 15 years the freedom from moderate to severepulmonary insufficiency and/or peak gradient >40 mmHg was 88.8 ± 2.6%, andthe event-free survival was 87.0 ± 2.8%.TUESDAYAfternoonCONCLUSION: The Ross procedure should not be performed in patients with AIdue to BAV. The long-term results in patients with aortic stenosis with or withoutBAV are excellent. This operation is an option for young adults with aortic stenosiswho choose a tissue valve.3:00 p.m. INTERMISSION – VISIT EXHIBITSExhibit Hall* AATS Member165