Redo Autograft Operations After the Ross Procedure

Background. Autograft dilatation after the Ross procedure is the most common cause of late autograft failure. We looked at results after reoperation for autograft dysfunction using autograft sparing and composite root replacement techniques. Methods. Data were abstracted from our prospectively collected Ross registry for 160 consecutive patients who underwent a Ross procedure by a single surgeon between 1994 and 2008. Follow-up records were obtained, and the last echocardiographic report after reoperation was analyzed. Results. Autograft reoperation was necessary in 17 patients, at a median interval of 6.9 years after the original procedure. Indications for reoperation were insufficiency with autograft dilatation in 16 patients, and without dilatation in 1 patient. Surgical procedures used at reoperation included autograft reimplantation in 6 patients (35.3%), autograft remodeling procedure in 1 patient (5.9%), composite root replacement with mechanical valved conduit in 5 patients (29.4%), composite root replacement with biologic valved conduit in 3 patients (17.6%), and mechanical aortic valve replacement in 2 patients (11.8%). At a median follow-up of 5.0 years after reoperation, freedom from greater than 2+ aortic insufficiency was 100% (17 of 17 patients) in both reimplantation and replacement groups. There was 1 death after reoperation (at > 14 years) related to complications from systemic lupus erythematosus. There have been no strokes after autograft reimplantation. Conclusions. Autograft valve reimplantation and composite aortic root replacement are effective treatments for aortic root dilatation and aortic insufficiency after the Ross procedure. Echocardiographic follow-up demonstrates reasonable short-term function after autograft preservation procedures. (Ann Thorac Surg 2012;93:1477-82) (c) 2012 by The Society of Thoracic Surgeons