Current Opinion in Cardiology, 1999 14:90-94
Book Chapter written by John D. Oswalt, M.D.
During the 31 years since the initial Ross procedure, data have been collected that have been helpful in assessing long-term performance of the autograft. The ongoing study of the pulmonary autograft supports the use of the Ross procedure in young patients, in females of childbearing age, and in patients with congenital aortic stenosis and complex left ventricular outflow tract obstruction. We continue to see little or no thromboembolism despite no anticoagulation therapy. The remarkable ability of the autograft to grow in children is extremely beneficial. Additionally, excellent results have been obtained in some series for the treatment of endocarditis. Recently, the autograft has performed similarly to a normal aortic valve under high stress. Changes in implantation techniques transitioning from subcoronary to root replacement and performing annular narrowing has decreased the incidence of early regurgitation. A potential for an immune response with resulting pulmonary stenosis and possible early explantation of the pulmonary homograft exists; however, overall, results of the Ross procedure are excellent and highly reproducible.
Although Donald Ross first performed the Ross procedure (ie, autograft replacement of the aortic valve) in 1967, acceptance of this procedure in the United States did not begin until the late 1980s. Since then and following Ross’ 20-year follow-up paper, the procedure has steadily gained acceptance. The Ross Procedure International Registry has been established to trace outcomes that in time may suggest both how well the procedure performs and alternatives in operative technique. The registry currently reports 197 surgeons performing the Ross procedure in 153 centers worldwide. Early mortality rates, which are comparable to other aortic valve procedures (2.5%), makes the autograft replacement of the aortic valve a truly viable option for several complex groups of patients. These complex groups include children and young adults, females of childbearing age, patients with aortic endocarditis (native or prosthetic), and patients with left ventricular outflow tract obstruction. The fact that autograft replacement requires no anticoagulation therapy postoperatively allows autograft recipients freedom from thromboembolic events and also allows them to pursue active lifestyles. In addition, follow-up in children post-Ross procedure has remarkably shown that the autograft can grow with the child.
Because of this growth potential, the Ross procedure is the valve of choice for congenital aortic stenosis and for complex left ventricular outflow tract obstruction. Sixty-three percent of patients undergoing a Ross procedure are aged 11 to 40 years. Elkins et al.