Autograft Durability after Ross Operation: Gender Is More Important Than Aortic Valve Cusp Number According to 17-Years Results after 621 Operations of a Single Center

Background: Patients with bicuspid aortic valves (AV) are suspected to have weaker connective tissue than patients with normal AVs, resulting in higher rates of late aortic dilatation or aneurysm. If the pulmonary valve of such patients is used as autograft in Ross patients, this tissue weakness might affect durability of the pulmonary valve in aortic position.

Patients and Methods: From 1995 to 2012, 660 Ross operations were performed at site (2). Patient age: mean 42 ± 14, median 45 years; 77% were men. Among all, for 621 patients, CN and at least one postoperative examination were documented. A total of 3,982 standardized echo examinations were performed within a total follow-up time of 4112 years. Ninety valves (15%) were unicuspid, 58% bicuspid. We calculated freedom from AV reoperation, stenosis, insufficiency, degeneration related to CN, age, gender, and Cox regression models for multivariate analyses.

Results: Significant findings were as follows: less overall degeneration in female patients (p= 0.042 in univariate and 0.05 in both Cox regression models); less insufficiency in female patients (p= 0.018 and 0.028, respectively).

Fig. 1: Freedom from at least moderate insufficiency

Conclusion: This large single center experience shows advantages for women regarding freedom from neoaortic valve insufficiency and overall degeneration rates, mainly in the first 10 years after the Ross operation. The number of cusps was unimportant regarding freedom from insufficiency or reoperation.