Pulmonary Autograft Mitral Valve Replacement (Ross II Procedure): More Than Two Decades of Follow-up From a Single Center in the United States

Background We aim to elucidate the outcomes of patients who underwent a Ross II procedure at our institution. Methods Eight patients underwent a Ross II procedure at our institution between 2002 and 2008. Electronic medical records were queried to obtain demographic, procedural, and recent follow-up data. Results The mean follow-up time for this cohort is 17 ± 6.2 years, and the pulmonary autograft has stayed in place, on average, for 9.6 ± 8.3 years. At last follow-up, the average pulmonary autograft mean gradient was 6.1 ± 2.4 mm Hg. No new mitral valve reoperations have been required since our last publication. Three early patients developed at least moderate pulmonary homograft (PH) regurgitation, although none of the patients in this cohort had significant PH stenosis at their last follow-up. None of the patients with a pulmonary homograft have required reintervention to date. There have been three deaths in this cohort, two of which were outlined in our previous study. More recently, Patient 2—who underwent a Ross II procedure to surgically correct rheumatic mitral valve stenosis and regurgitation—died 17 years after her operation due to complications of diabetic ketoacidosis. Conclusion To our knowledge, this study represents the longest follow-up of a Ross II cohort ever reported, and the largest experience with the procedure in North America. The Ross II procedure offers a durable tissue alternative to conventional prosthetic valves for mitral valve replacement, particularly in younger patients, women of childbearing age, and those who have a contraindication to anticoagulation.