1086-137 Impairment of left atrial appendage mechanical function following electrical isolation with epicardial radiofrequency bipolar ablation

Background: The Ross Procedure (pulmonary autograft replacement of the aortic valve) has become a very useful option in young patients with isolated aortic valve disease. There has been concern about using this option in patients with ascending aortic dilatation or aneurysm. This study was designed to examine whether an aggressive approach to repairing or replacing the dilated ascending aorta could be safely combined with the modified Ross Procedure. Methods: Fifty-six of 339 consecutive adult patients undergoing the modified Ross Procedure over 16 years had replacement (15) or reduction (41) of the ascending aorta. This included 47 men and 9 women with an average age of 43.8 years. Of the 15 graft replacement patients, the autograft root was supported with either an external “jacket” of graft material (10) or residual native aorta (3). Thirteen graft replacement patients required hypothermic circulatory arrest averaging 20 minutes. Thirty-seven patients had elliptical lateral aortorrhaphy and 4 had closed plication. Cardiac ischemic time averaged 180 minutes for graft replacement and 156 minutes for aortorrhaphy versus 145 minutes for patients without concomitant procedures. Results: There was one operative death (from sepsis) for a 1.8% mortality compared to 2.2% (6/283) without ascending aortic surgery. Two other patients survived major complications – right ventricular failure and reversible neurologic deficit. Discharge echocardiograms of the 55 survivors revealed no or trace aortic regurgitation in 39 and mild in 16 patients. All returned to Class I functional status. No patients have required further surgery. Follow up echo data show only one patient (un-“jacketed”) with evidence of root dilatation. Conclusion: The modified Ross Procedure can be safely extended to include patients with a dilated or aneurysmal ascending aorta using an aggressive approach to repair or replacement.