Pulmonary valve repair at the time of the Ross procedure: a safe and durable strategy to address post-implantation aortic regurgitation.

Abstract

Background: Contemporary evidence supports use of the Ross procedure (pulmonary autograft) to treat patients with aortic valve disease. No studies have evaluated the impact of autograft repair to correct residual aortic regurgitation (AR) at index Ross on late outcomes.

Methods: This study includes patients undergoing a Ross procedure followed by concomitant autograft valve repair at two institutions. Autograft repair was defined as correction of residual AR during the same admission for the Ross procedure.

Results: Between 2011 and 2024, 675 patients underwent a Ross procedure in 2 large volume institutions. Of them, 22 (3%) underwent autograft repair for post-procedural AR (mean age: 52 yo, 23% female). Fourteen patients had a bicuspid valve (64%) and 5 had a unicuspid aortic valve (23%). One patient had a bicuspid autograft. Residual AR was eccentric in 8 patients (36%), commissural in 9 (41%) and combined in 5 (23%). AR was corrected using central plication sutures in 13 patients (59%) and commissuroplasty in 14 patients (63%). There were no perioperative deaths. One patient required reintervention and conversion to a Bentall procedure 6 days after the index Ross procedure. All but one (5%; mild AR) had none/trivial AR on discharge. At a median echocardiographic follow-up of 3 years (Q1-Q3: 2-8), seven patients have mild AR (32%), and one patient developed mild-to-moderate AR after 7 years. All other patients have no/trivial AR. At 5 years, the cumulative incidence of AR>2 is 6±6%.

Conclusions: Addressing post-procedural AR after autograft implantation is safe and associated with durable outcomes in the first decade. These findings support correction of post-procedural commissural and/or eccentric jets at the time of index operation.