The ross procedure as the surgical treatment of active aortic valve endocarditis

Background and aim of the study: The authors' expe-rience is reported of aortic valve replacement (AVR) using the pulmonary autograft in patients with active aortic valve endocarditis, including an urgent Ross procedure in infants with the acute condition. Methods: Nine patients aged between 8 months and 38 years, with a diagnosis of aortic valve endocardi-tis, have undergone AVR using the Ross procedure at the authors' institution since October 1997. The diag-nosis was established by clinical and echocardio-graphic findings. Indications for surgery were severe aortic insufficiency and congestive heart failure in all patients, with the addition of thromboembolic events (n = 3), persistent hyperpyrexia (n = 3) and vegetations (n = 5). Four infants with no history of congenital cardiac malformation underwent urgent surgery because of acute bacterial endocarditis and rapid hemodynamic deterioration. Blood cultures were positive for Streptococcus pneumoniae in three patients, and Kingella kingi and Staphylococcus aureus in one patient each. Four patients were cul-ture-negative. All patients were treated with intra venous antibiotics for four to six weeks postopera-tively. Results: There were no perioperative or late deaths, and no recurrent endocarditis at the implanted valves. Echocardiographic evaluation at discharge showed trivial to mild aortic insufficiency, with no stenosis at the left ventricular outflow tract. Similar findings were found across the right ventricular out-flow tract. At follow up (range: 4 months to 5.5 years), none of the patients showed progression of aortic valve insufficiency or developed stenosis; three had mild and moderate homograft stenosis (Doppler gra-dient 20-40 mmHg), and all children had moderate homograft insufficiency. Conclusion: The Ross procedure is an excellent ther-apeutic option for active aortic valve endocarditis in young patients, and demonstrates low morbidity and mortality. Early surgery may be indicated in patients with acute aortic valve endocarditis because of the rapidly progressive nature of this disease.