Autograft reintervention after the Ross surgery: predictive factors in a prospective series

Purpose: Ross intervention is an alternative to mechanical prosthesis implantation in children and young adults who need aortic valvular replacement.Autograft regurgitation and the need of autograft reintervention are possible complications in these patients. Our Aim was to identify predictive factors of autograft reintervention in a prospective series of a reference cardiovascular surgery hospital. Methods: Since November 1997 to July 2009, a total of 107 patients diagnosed of aortic stenosis, aortic regurgitation or aortic double lesion requiring surgical treatment underwent Ross surgery (mean age 30±11 years, 69% male, 89 patients>14 years). In all of them, a comprehensive clinical and echocardiographic evaluation was performed before the intervention and at discharge, at 6, 12 months and annually after surgery. Results: After up to 15 years of follow up (median 11 years, interquartile rank 9-13 years) 11 patients (10%) required autograft reintervention. Probability of survival free from autograft reintervention at 5 and 10 years was 95% and 89%, respectively. In global series, a larger native pulmonary annulus size was the only factor, associated to autograft reintervention (HR 1.30, IC 95% 1.02-1.73, P=0.03). In patients aged>14 years, univariate analysis showed a significant association of larger native pulmonary annulus size (p=0.03) with autograft reintervention, and a non significant trend for larger native aortic annulus diameter (p=0.08) and double aortic lesion or aortic regurgitation versus pure aortic stenosis (p=0.09). In multivariate analysis, only a larger native pulmonary size (HR 1.38, IC 95% 1.027-1.863, P=0.03) resulted an independent predictive factor of autograft reintervention. Conclusion: Long term after Ross surgery, a not negligible percentage of patients required autograft reintervention. A larger size of the native pulmonary annulus predicted, independently, the need of autograft surgery in the global series and in adult patients.