Dilatation of the pulmonary autograft and native aorta after the Ross procedure: A comprehensive echocardiographic study

Objectives Dilatation of the pulmonary autograft has been observed after the Ross procedure. Whether the remaining native aorta dilates is not known. The aim of the study was to describe the prevalence and severity of autograft and native aortic dilatation over time and to identify possible determinants. Methods Ninety-one adult patients underwent the Ross procedure with the full root replacement technique. In 31 (34%) patients, the ascending aorta was downsized during surgical intervention. A baseline postoperative echocardiographic investigation was performed. A comprehensive investigation of the aorta from the annulus to the proximal descending aorta was performed (n = 71) after a median follow-up of 8.9 years. An intermediate investigation was performed (n = 29) after a median of 7.6 years. Autograft and native aortic dimensions were compared over time and with those of a control group (n = 38). For each patient in the study group, the expected aortic dimensions were predicted based on findings in the control group. Enlargement was defined as a z score of greater than 1.96 from the predicted value. Results The autograft and native aortic dimensions increased significantly from baseline to the intermediate follow-up and continued to increase to the final follow-up. The proportion of patients with enlarged autografts and proximal ascending aortas was 13% and 16% at baseline, increasing to 33% ( P = .006) and 44% ( P = .0014), respectively, at the end of follow-up. Enlargement of the aorta at the final follow-up was related to larger baseline pulmonary autograft dimensions but not to native bicuspid valve or the need to downsize the aortic root. Conclusions Pulmonary autograft dilatation is common after the Ross procedure in adults. The dilatation progresses over time and is often accompanied by dilatation of the native aorta.