The Ross procedure versus repair for treatment of a unicuspid aortic valve in adults

• Published in: European journal of cardio-thoracic surgery 2023-07, Vol.64 (1)
• Main Authors: Abeln, Karen B, Matsushima, Shunsuke, Ehrlich, Tristan, Giebels, Christian, Schäfers, Hans-Joachim
• Format: Article
• Language: English
• Subjects: Adult; Aortic Valve - surgery; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - surgery; Autografts; Conventional Valve Operations; Female; Follow-Up Studies; Humans; Male; Pulmonary Valve - transplantation; Reoperation; Transplantation, Autologous; Treatment Outcome; Young Adult
• ISSN: 1873-734X; 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezad118

Abstract OBJECTIVES Aortic stenosis or regurgitation in patients with a unicuspid valve morphology requires interventions early in life. We have performed either primary valve repair or the Ross procedure. The goal of this study was to compare the midterm results of repair and pulmonary autograft replacement. METHODS Between December 1998 and April 2022, a total of 345 patients (77% male; mean age 34 ± 9.7 years) underwent treatment of a unicuspid aortic valve. Patients were excluded if they were 54 years (n = 3) at the time of the operation. The remaining cohort was divided into 2 groups: 167 (64%) patients underwent valve repair; 91 (36%) patients underwent pulmonary autograft replacement. The indications for surgery were aortic regurgitation (n = 104), aortic stenosis (n = 45), combined disease (n = 103) and endocarditis (n = 6). Fifty-one patients had root dilatation (>43 mm) with aortic regurgitation (repair n = 23; Ross n = 28). Mean follow-up was 5.9 years (SD: 5 years) [range 0.1–22.3 years]. RESULTS There were 1 early and 3 late deaths; 47 patients required reintervention. Survival at 10 years was 95% in the Ross group and 97% after valve repair (P = 0.769). Freedom from reintervention at 10 years was 98% in the Ross group and 80% after valve repair (P = 0.012). A receiver operating characteristics curve analysis showed a trend towards better durability in patients < 26 years. CONCLUSIONS The ideal treatment of the unicuspid aortic valve remains debatable. Repair of a unicuspid valve can be considered a bridge to pulmonary autograft replacement, at least in younger patients. The appropriate times to replace and to repair require further investigation. The unicuspid valve is a relatively rare variant of the aortic valve even though its prevalence is likely underestimated at the time of echocardiography or aortic valve surgery [1, 2].