Do surgical modifications at the annular level during the Ross procedure negatively influence the structural and functional durability of the autograft?†

OBJECTIVES: Do surgical modifications at the annular level (e.g. the modified Ross-Konno procedure or reduction plasty) influence the structure and function of the Ross autograft at the mid-term follow-up? METHODS: From June 2001 to July 2009, 49 patients (37 men and 12 women), mean age 10.5 ± 5.7 years (range 2 weeks to 17.8 years), underwent Ross operations. Twenty-one patients underwent additional aortic annulus reduction plasty and 9 patients a modified Ross-Konno procedure. The need for reintervention, reoperation and valve function were retrospectively analysed for a mean follow-up of 4.6 ± 2.7 years (range 9 days to 9.2 years). RESULTS: There were no intraoperative or early death. Three late deaths occurred. Survival at 4 years was 91.9 ± 4.6%. In the overall cohort, aortic annular growth was 1 mm/year, corresponding to a z-score increase of 0.24/year (no mismatch group), 0.21/year (reduction plasty group) and 0.34/year (Ross-Konno group). At the last follow-up, sinotubular junction z-scores were 2.8 ± 1, 3 ± 1 and 2.4 ± 0.9 in the no mismatch, reduction plasty, and Ross-Konno groups, respectively. Ninety-three percent of patients presented with none-to-mild autograft valve regurgitation. The Ross-Konno group showed a significant increase in aortic annulus size (z-score of the annulus at the last follow-up 3.6 ± 1.6; P = 0.036). The no mismatch and the reduction plasty groups showed z-scores within the normal range (2.1 ± 1.7 and 2.5 ± 1.6, respectively). CONCLUSIONS: Additional aortic annulus reduction or enlargement does not disturb the structural and functional durability of the autograft at the mid-term follow-up. Long-term autograft integrity, especially in the Ross-Konno group, remains to be investigated.