Hemodynamic performance at rest and during exercise after aortic valve replacement: comparison of pulmonary autografts versus aortic homografts

Abstract

Background: The Ross procedure and aortic homografts have both been shown to have superior hemodynamic performance after valve replacement, but there have been few comparisons.

Methods: Sequential Doppler echocardiograms were performed up to 5 years after aortic valve replacement in 132 patients with the Ross procedure and 111 patients with an aortic homograft (AH). Measurements included assessment of valvular regurgitation and calculations of valve effective orifice area (EOA) and mean transvalvular gradients; the same measurements were also performed at the level of the pulmonary homograft in the Ross patients as well as during maximum exercise in 20 Ross patients and 14 AH patients.

Results: Aortic valve hemodynamics were stable during follow-up for both procedures and values at 1 year showed larger indexed EOAs (1.77+/-0.45 versus 1.42+/-0.35 cm(2)/m(2), P<0.001) and lower gradients (2+/-3 versus 4+/-3 mm Hg) for the Ross procedure; similar findings were also observed during exercise (1.99+/-0.44 versus 1.36+/-0.39 cm(2)/m(2), P<0.001 and 7+/-3 versus 17+/-11 mm Hg). Prevalence and severity of aortic regurgitation were low in both groups, although 4 patients (1 Ross, 3 AH) underwent a second operation for this reason. Also, various degrees of pulmonary homograft stenosis were found in 20% of Ross patients, 4 of which underwent a second operation.

Conclusion: Both procedures provide continued excellent hemodynamics of the aortic valve. The Ross procedure has a slight advantage, but this is somewhat counterbalanced by the deterioration of the pulmonary homograft in up to 20% of patients. Further studies aimed at clarifying longer-term outcomes as well as preventing pulmonary homograft stenosis with the Ross operation are clearly needed.