Pulmonary valve repair at the time of the Ross procedure: A safe and durable strategy to address postimplantation aortic regurgitation.

Abstract

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 at the index Ross procedure on late outcomes. This study includes patients undergoing a Ross procedure followed by concomitant autograft valve repair at 2 institutions. Autograft repair was defined as correction of residual aortic regurgitation during the same admission for the Ross procedure. Between 2011 and 2024, 675 patients underwent a Ross procedure in 2 large-volume institutions. Of them, 22 (3%) underwent autograft repair for postprocedural aortic regurgitation (mean age, 52 years; 23% were female). Fourteen patients had a bicuspid valve (64%), and 5 patients had a unicuspid aortic valve (23%). One patient had a bicuspid autograft. Residual aortic regurgitation was eccentric in 8 patients (36%), commissural in 9 patients (41%), and combined in 5 patients (23%). Aortic regurgitation 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 patients but 1 (5%; mild aortic regurgitation) had no or trivial aortic regurgitation on discharge. At a median echocardiographic follow-up of 3 years (Q1-Q3: 2-8), 7 patients have mild aortic regurgitation (32%), and 1 patient developed mild-to-moderate aortic regurgitation after 7 years. All other patients have no or trivial aortic regurgitation. At 5 years, the cumulative incidence of aortic regurgitation greater than 2 is 6% ± 6%. Addressing postprocedural aortic regurgitation after autograft implantation is safe and associated with durable outcomes in the first decade. These findings support correction of postprocedural commissural or eccentric jets at the time of index operation.