Maria C. Escarain, Gustavo Giunta, Roberto R. Favaloro
Favaloro Foundation University Hospital, Buenos Aires, Argentina
Background and aim of the study: Reintervention after the Ross procedure (RP) remains a concern. Hence, the study aim was to assess the long-term results of the RP in adults and to identify predictors of reoperation.
Methods: Between 1995 and 2012, a total of 263 consecutive patients (189 males, 74 females; mean age 42 ± 14 years) underwent the RP, using the freestanding root technique. The mean follow up was 7.5 ± 5.0 years and was 94% complete. Survival, and freedom from autograft, homograft and Ross-related reoperation were analyzed using Kaplan-Meier analysis, while Cox proportional hazard regression was used to identify predictors of reoperation.
Results: Early mortality was 2.6% (n = 7) and late mortality 4.9% (n = 14). Survival at 13 years was 90% (95% CI 80-95%). Freedom from homograft, autograft and Ross-related reoperation at 13 years were
97% (95% CI 90-99%), 92% (95% CI 82-96%) and 90% (95% CI 81-95%), respectively. No predictors of homograft reoperation were identified. Freedom from autograft reoperation was not significantly different for patients with preoperative aortic insufficiency (AI) (88%; 95% CI 74-95% at 13 years) compared to those with aortic stenosis (96%; 95% CI 84-99% at 13 years), or both (86%; 95% CI 51-97% at 13 years) (p = 0.62). Other variables (gender, aortic/pulmonary mismatch and aortic annulus diameter) were not significantly associated with the need for autograft reoperation.
Conclusion: Despite its complexity and reoperation rate, RP should be considered as a valid surgical option for aortic valve disease treatment in selected patients. Among the present series, no predictors for homograft or autograft reoperation were identified.
The Journal of Heart Valve Disease 2015;24:247-252
|Ross Procedure in Adults: Is Reoperation a Real Concern?|
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