Geometric mismatch of the aortic and pulmonary roots causes aortic insufficiency after the Ross procedure.

BACKGROUND

Geometric mismatch between the two semilunar valves can cause aortic insufficiency after the Ross procedure. Thus, whenever the aortic root is larger than the pulmonary root, surgical reduction of the aortic anulus or of the sinotubular junction (or both) to match the diameters of the pulmonary root is necessary to prevent late malfunction of the pulmonary autograft.

METHODS

The Ross procedure was performed in 81 patients during the past 5 years. The diameters of the aortic and pulmonary roots were measured in 77 patients. Reduction of the aortic anulus and of the sinotubular junction was necessary in 27 patients, reduction of the aortic anulus alone in 12, and reduction of the sinotubular junction alone in 10. The pulmonary autograft was implanted in the subcoronary position in the aortic root in two patients, as a complete root replacement in 58, and as an inclusion root in 21.

RESULTS

There was one operative death, caused by myocardial infarction. Aortic insufficiency developed in one patient who did not have measurement and reduction of the aortic anulus, and aortic root replacement was necessary 2 weeks later. Patients have been followed up from 2 to 64 months (mean 15 months). Two patients have required late reoperations: one because of pulmonary artery stenosis and the other because of a false aneurysm between the autograft and the mitral valve. The most recent Doppler echocardiographic study shows that 90% of the patients have only trace or no aortic insufficiency, and 10% have mild aortic insufficiency.

CONCLUSION

This experience suggests that adjustment of the diameter of the aortic anulus or of the sinotubular junction of the aorta may be important to prevent aortic insufficiency after the Ross procedure.