OBJECTIVE: Although the pulmonary autograft is forgiving minor size discrepancies between autograft and aortic root, gross size differences may require root tailoring as annulus reduction or root enlargement. This may have some influence on the function of the autograft, which is not well known in the subcoronary technique.

METHODS: Between 06/94 and 01/01 the Ross procedure was performed with the subcoronary technique in 165 patients (mean age 46±14.0, range 15-70 years). Twenty-six patients received an annuloplasty (strip of Dacron or autologous pericardium between the right and left fibrous trigones) to reduce the annulus diameter to sizes between 23 and 25 mm (group A), in eight an enlargement of the aortic root with autologous pericardium was necessary (group B), in 131 no tailoring was performed (group C). Last follow up investigations including echocardiographic determinations of hemodynamic variables, autograft and homograft function were applied at a mean follow-up of 19.4±18.9 months. The hospital (1 patient, 0.5 %) and late mortality (2 patients, non-cardiac cause of death) were low. Two patients were lost to follow up.

RESULTS: Age at operation was significant lower in group B (p=.004). At last examination there were no differences concerning autograft function. No differences were found in NYHA-class (p=.669), left ventricular ejection fraction (EF; p=.256) and cardiac output (CO; p=.215). Regarding the time course of aortic insufficiency there was no change in group A and B, a slight, but insignificant progression in group C (p=.054).

CONCLUSION: Size discrepancies between autograft and aortic root can be corrected by annulus reduction or root enlargement in the subcoronary position with excellent resulting autograft function.