Modification of the Ross aortic valve replacement to prevent late autograft dilatation

Objective: Aortic root dilatation with and without aortic regurgitation is seen in up to 20% of patients undergoing a Ross aortic root replacement at late follow-up. We present our early experience with reduction annuloplasty combined with prosthetic Dacron graft replacement of the aorta above the autograft to prevent late dilation after a Ross aortic root replacement. Methods: Since 2001, 31 of 97 adult and paediatric patients (mean age 28.8 ± 14.4 years; range 8–53 years) with bicuspid aortic valve and dilatation of the ascending aorta underwent a modified Ross procedure with reduction annuloplasty combined with prosthetic Dacron graft replacement of the ascending aorta. The diameter of the ascending aorta was measured before and early after surgery and then between 3 months and 8 years’ follow-up (mean, 2.5 ± 2.2 years). Results: There were no early or late deaths. Reduction annuloplasty combined with ascending aortic graft replacement decreased the diameters of the ascending aorta from 42 ± 7.0 mm preoperatively to 25 ± 2.9 mm early after surgery (p ≪ 0.001). During follow-up, there was no significant increase of the aortic diameter compared with that during the postoperative period (27 ± 4.3 mm; p = 0.07). The root diameter increased in only 3 of 31 patients (10%). No patient underwent re-operation. At last follow-up, mild (n = 18) or trivial (n = 13) aortic regurgitation was observed. Conclusion: Ross aortic root replacement combined with reduction annuloplasty and Dacron graft replacement of the ascending aorta demonstrated excellent early- to mid-term results in patients with bicuspid aortic valve and dilatation of the ascending aorta. Continued use and long-term follow-up imaging is necessary to further demonstrate the value of this technical modification.