Endocarditis following the Ross procedure: the advantage of a living valve

Background: Large observational studies have shown a rapid increase in the incidence of prosthetic valve endocarditis(PVE), due to the increasing number of patients receiving heart valve substitutes.Recently,a renewed interest has gathered around the Ross procedure(pulmonary autograft) for the treatment of aortic valve disease (AVD) in adults.Being the only available living aortic valve substitute,the pulmonary autograft is thought to be more resistant to PVE.Aim of this study was to investigate the incidence of infective endocarditis (IE) following the Ross operation. Materials and methods: We performed a post hoc analysis of a randomized clinical trial comparing AVD surgical patients undergoing homograft root replacement or the Ross procedure.In this study, the principal focus was to analyse long-term IE incidence after the Ross procedure. Results: From September 1,1994 to May 31,2001,a total of 108 patients (16 female, median age 38 years) received a pulmonary autograft. Aortic stenosis was present in 30 (28%),regurgitation in 49(45%) and mixed disease in 29 (27%) cases.Nine patients(8%) had active endocarditis and 45(42%) were redo operations.There was only one perioperative death(0.9%).During a median follow-up of 24.1 years (IQR, 22.6-26.1 years),there was 1 case of autograft endocarditis (0.04% per year) which was treated conservatively, and 9 cases of homograft endocarditis (0.36% per year). Conclusions: Infective endocarditis following the Ross procedure is rarely observed in the pulmonary autograft.The incidence of homograft endocarditis is consistent with the data in the literature.These data further support the importance of a living valve substitute and encourage the development of bioengineered valves.