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

Abstract

Background Aortic stenosis or regurgitation in patients with a unicuspid valve morphology require interventions early in life. We have performed either primary valve repair or the Ross procedure. The aim of this study was to compare the mid-term results of repair and pulmonary autograft replacement. Methods Between 12/1998 and 04/2022, 345 patients (77% male; mean age 34±9.7 years) underwent treatment of a unicuspid aortic valve. Patients were excluded if they were <18 years (n = 84) or > 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 (>43mm) with aortic regurgitation (repair n = 23; Ross n = 28). Mean follow-up was 5.9 (SD: 5 years) [range 0.1 to 22.3 years]. Results There was 1 early, 3 late deaths, and 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 ROC curve analysis showed a trend towards better durability in patients < 26 years. Conclusion 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 time when to replace and when to repair requires further investigation.