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European Heart Journal Advance Access originally published online on February 15, 2007
European Heart Journal 2007 28(16):1993-2000; doi:10.1093/eurheartj/ehl550
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The Ross operation: a Trojan horse?{dagger}

Loes M.A. Klieverik1,*, Johanna J.M. Takkenberg1, Jos A. Bekkers1, Jolien W. Roos-Hesselink2, Maarten Witsenburg3 and Ad J.J.C. Bogers1

1 Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Bd 571, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
2 Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
3 Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands

Received 6 October 2006; revised 22 December 2006; accepted 25 January 2007; online publish-ahead-of-print 15 February 2007.

* Corresponding author. Tel: +31 10 463 4481; fax: +31 10 463 3993. E-mail address: l.klieverik{at}erasmusmc.nl

Aims: The Ross operation is the operation of choice for children who require aortic valve replacement (AVR) and may also provide a good option in selected adult patients. Although the autograft does not require anticoagulation and has a superior haemodynamic profile, concern regarding autograft and allograft longevity has risen. In this light, we report the 13-year results of our prospective autograft cohort study.

Methods and results: Between 1988 and 2005, 146 consecutive patients underwent AVR with a pulmonary autograft at Erasmus Medical Center Rotterdam. Mean age was 22 years (SD 13; range 4 months–52 years), 66% were male. Hospital mortality was 2.7% (N = 4); during follow-up four more patients died. Thirteen-year survival was 94 ± 2%. Over time, 22 patients required autograft reoperation for progressive neo-aortic root dilatation. In addition, eight patients required allograft reoperation. Freedom from autograft reoperation at 13 years was 69 ± 7%. Freedom from allograft reoperation for structural failure at 13 years was 87 ± 5%. Risk factors for autograft reoperation were previous AVR and adult patient age.

Conclusion: Although survival of the Rotterdam autograft cohort is excellent, over time a worrisome increase in reoperation rate is observed. Given the progressive autograft dilatation, careful follow-up of these patients is warranted in the second decade after operation.

Key Words: Ross operation • Prospective study • Survival • Autograft dilatation • Reoperation

{dagger} Presented at the World Congress of Cardiology in Barcelona, Spain, on 4 September 2006.


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