Martin Andreas1, Gernot Seebacher2, Eric Reida2, Dominik Wiedemann2, Christiane Pees3, Raphael Rosenhek4, Georg Heinze5, Anton Moritz6, Alfred Kocher2, Guenther Laufer2. 1. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: martin.andreas@meduniwien.ac.at. 2. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 3. Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. 4. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria. 5. Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria. 6. Department of Thoracic, Cardiac and Thoracovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Abstract
BACKGROUND: The Ross procedure offers several potential advantages in a young patient population. The widespread use of the procedure is still limited due to the technical challenge. Pulmonary homograft stenosis and autograft dilatation remain a matter of concern. We present the long-term outcome in a single center with special emphasis on mortality and need for valvular reintervention. METHODS: All patients who received a Ross procedure as freestanding root replacement (modified Yacoub technique) at our institution between 1991 and 2011 were followed. Descriptive statistical methods and Kaplan-Meier analyses were performed. RESULTS: A total of 246 patients (191 males, 55 females) underwent the Ross procedure during the study period. There were 176 adults and 70 pediatric patients with an average age of 36 ± 10 and 10 ± 5 years, respectively. The median follow-up was 10 years. Twelve (4.9%) subjects were lost to follow-up. Early mortality was 1.6%. Overall mortality was comparable with an age and sex matched population for adult patients. The linearized risk for reoperation per patient-year was 0.6% for the autograft and 0.6% for the right ventricular outflow tract, with a mean time to surgery of 6.4 ± 4.9 years. Overall freedom from reintervention was 95% at 5 years, 88% at 10 years, and 81% at 15 years. CONCLUSIONS: The Ross procedure provides good early results and an excellent long-term survival. It represents an excellent method of aortic valve replacement in children and young adults. Root reinforcement techniques and aortic reduction plasty may be beneficial, especially in adult patients with native aortic valve regurgitation.
BACKGROUND: The Ross procedure offers several potential advantages in a young patient population. The widespread use of the procedure is still limited due to the technical challenge. Pulmonary homograft stenosis and autograft dilatation remain a matter of concern. We present the long-term outcome in a single center with special emphasis on mortality and need for valvular reintervention. METHODS: All patients who received a Ross procedure as freestanding root replacement (modified Yacoub technique) at our institution between 1991 and 2011 were followed. Descriptive statistical methods and Kaplan-Meier analyses were performed. RESULTS: A total of 246 patients (191 males, 55 females) underwent the Ross procedure during the study period. There were 176 adults and 70 pediatric patients with an average age of 36 ± 10 and 10 ± 5 years, respectively. The median follow-up was 10 years. Twelve (4.9%) subjects were lost to follow-up. Early mortality was 1.6%. Overall mortality was comparable with an age and sex matched population for adult patients. The linearized risk for reoperation per patient-year was 0.6% for the autograft and 0.6% for the right ventricular outflow tract, with a mean time to surgery of 6.4 ± 4.9 years. Overall freedom from reintervention was 95% at 5 years, 88% at 10 years, and 81% at 15 years. CONCLUSIONS: The Ross procedure provides good early results and an excellent long-term survival. It represents an excellent method of aortic valve replacement in children and young adults. Root reinforcement techniques and aortic reduction plasty may be beneficial, especially in adult patients with native aortic valve regurgitation.
Authors: William H Ryan; John J Squiers; Katherine B Harrington; Tammy Goodenow; Courtney Rawitscher; Justin M Schaffer; J Michael DiMaio; William T Brinkman Journal: Ann Cardiothorac Surg Date: 2021-07