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CLINICAL STUDY: CARDIAC SURGERY

Up to seven years of experience with the Ross procedure in patients >60 years of age

^a Department of Cardiac Surgery, Medical University of Luebeck, Luebeck, Germany

Manuscript received August 6, 1999; revised manuscript received March 16, 2000, accepted April 28, 2000.

Reprint requests and correspondence: Prof. Dr. Hans-H. Sievers, Department of Cardiac Surgery, Medical University of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany
schmidtk{at}medinf.mu-luebeck.de

OBJECTIVES

The objective of this study was to compare the outcome of patients >60 years of age with younger patients after the Ross procedure.

BACKGROUND

Currently, the Ross procedure is performed predominantly in young patients. Main arguments against the Ross procedure in the elderly are the complexity of the operation and related risks. Experience with the Ross procedure in patients >60 years of age is scarce.

METHODS

Between February 1990 and August 1998, the Ross procedure was performed in 27 patients (15 men and 12 women) >60 years of age (mean 64.2 ± 3.1 years, range 60.5 to 70.6; group A) and in 84 patients (68 men, 12 women) <60 years of age (mean 43.8 ± 12.4 years, range 15.2 to 59.4; group B). Echocardiography was applied at a mean follow-up of 28.4 ± 21.0 and 25.2 ± 21.4 months, respectively, to determine hemodynamic variables (ejection fraction, fractional shortening, stroke volume, cardiac output), cardiac dimensions and autograft and homograft valve function.

RESULTS

There was one early and one late (esophageal bleeding) death in group B; the mortality rate was 0% in group A. One autograft was replaced because of a subvalvular aneurysm, and one patient was lost to follow-up (group B). There were no significant differences in cardiac dimensions, grade of insufficiencies across homografts and autografts and hemodynamic variables, except for a higher pressure gradient across the homograft in group B (maximal pressure gradient 11.3 ± 5.6 vs. 7.7 ± 4.6 mm Hg in group A). The median New York Heart Association functional class was I in both groups.

CONCLUSIONS

Our seven years of experiences (mean follow-up 28 months) indicate that the Ross procedure may be performed in selected patients >60 years of age without increased risk for mortality or complications in experienced centers.

Abbreviations and Acronyms   AR = aortic regurgitation   BP = blood pressure   CAD = coronary artery disease   ECG = electrocardiographic   LV = left ventricular, left ventricle

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