Exercise echocardiographic comparison of pulmonary autograft and aortic homograft replacements for aortic valve disease in adults.

BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft, or Ross procedure, has theoretical hemodynamic benefits over other aortic valve replacements. The hemodynamic performance of the pulmonary autograft and pulmonary homograft components of this procedure have not been well defined.

METHODS

Twenty patients with pulmonary autograft replacement of the aortic valve and six with aortic homografts underwent exercise echocardiography with assessment of exercise duration, left ventricular dimensions, mass, and function. Hemodynamics at rest and maximal exercise, including Doppler gradients and effective orifice area (EOA), were measured across the pulmonary autograft and aortic homograft valves. Doppler gradients across the pulmonary homograft valves were compared to native pulmonary valve gradients at rest and maximal exercise.

RESULTS

Both groups of patients had excellent self-reported and measured exercise capacity. In comparison to the aortic homograft, the pulmonary autograft had lower peak Doppler gradients across the neoaortic valve at rest (5 +/- 2 versus 11 +/- 4 mmHg; p = 0.027) and maximal exercise (10 +/- 5 versus 15 +/- 5 mmHg; p = 0.003) and larger indexed EOA. However, the Ross procedure patients had higher gradients across the pulmonary homograft both at rest (14 +/- 10 versus 3 +/- 1 mmHg; p < 0.001) and maximal exercise (25 +/- 22 versus 5 +/- 4 mmHg; p = 0.004). Two patients in the Ross procedure group had significant pulmonary homograft stenosis in short- or mid-term follow up.

CONCLUSION

In comparison to aortic homograft replacement of the aortic valve, pulmonary autograft replacement has superior hemodynamics at rest and during exercise. However, the pulmonary homograft replacement may develop hemodynamically significant stenosis after the Ross procedure.