Autologous Reconstruction of the right ventricular outflow tract during Ross procedure. Early and mid-term outcome

OBJECTIVE: The pulmonary autograft remains the best substitute for the aortic valve in children even though different drawbacks remained to be resolved as lack of homograft's availability and long-term deterioration. Recently, to addres these issues we employed a modification of the Ross procedure(Couetil technique). METHODS: Between 1996 and 2000, 39 patients underwent modified Ross operation, in our institutions, for reconstruction of the RVOT utilizing a direct anastomosis between the remaining main pulmonary artery (PA) and the infundibulum and creation of a monocusp tailored from the anterior PA wall. There were 26 (66.7%) males, mean age 20.7 years (range 5 to 42 years). 7(18%) patients underwent concomitant mitral valve repair. RESULTS. The overall hospital mortality was 3 (7.7%) (only in Massa series). Preoperatively, 2 of them presented endocarditis and impaired left ventricular function. One of them underwent re-exploration due to important bleeding and the other patient underwent reoperation due to mediastinitis in the 11th postoperative day. Both patients died in the 13th and 24tlh postoperative day respectively due to progressive congestive heart failure . All survived patients were contacted at follow-up time, mean 27 months. There were no other deaths. All patients resulted to be in NYHA class I or II . In 36 survivors, the echo-doppler at the aortic autograft showed none or trivial regurgitation in 31 (86%) patients and mild in 5 (14%). None or trivial incompetence across the PA monocusp was identified in 17 (47.2%) patients, mild in 13 (36%), moderate in 5 (13 .9%) and severe in 1 (2.8%). This patient underwent reoperation at 2 years after the first procedure due to right ventricular failure and severe tricuspid regurgitation. CONCLUSION: These acceptable outcomes support the employment of this modification for the Ross procedure especially in children and where the homograft facilities do not exist. Other series and longer follow-up should confirm these results.