Abstract 5841: Effect of autograft reinforcement techniques on autograft durability and function after the Ross procedure: Results from the German-Dutch Ross Registry
There is anecdotal evidence that concomitant autograft reinforcement interventions (aRI) during the Ross procedure may influence durability and function of the autograft. Aim of this prospective study is to evaluate the effect of aRI in a series of patients undergoing the Ross procedure. 1335 adult patients (1013 male; mean age 43.5± 12.0 years) underwent a Ross procedure (subcoronary technique, SC n= 637; root replacement technique, RR, n= 698). 595 patients (152 SC, 443 RR) required aRI due to aortic root pathology: anulus reinforcement n= 515, sinotubular junction reinforcement, n= 278. Regular clinical and echocardiographic follow-up visits were performed (mean follow-up 5.1± 3.7 years). Longitudinal assessment of autograft function with time was performed utilizing a hierarchical multilevel modelling technique. Autograft reoperation rates are displayed in the Table⇓. In total, SC had lower initial aortic regurgitation grades (ARg) (0.351 vs. 0.687, p< 0.001) compared to RR and a lower rate of AR with time (0.029 vs 0.039 ARg/y, p< 0.001). In RR reinforcement had no effect on initial ARg (0.748 vs. 0.681), however patients with RR and reinforcement showed no progression of ARg (−0,010 vs. 0,072 ARg/y, p< 0.001). In SC initial AR was greater in patients with aRI (0,435 vs. 0,312) while the rate of AR development did not differ. In all cases the SC technique resulted in lower initial AR compared to patients in the RR group with aRI (0,350 vs. 0,761 AIg, p< 0,000) or without aRI (0,350 vs. 0,661, p< 0,000). In Ross patients, RR with aRI techniques and SC revealed comparable results regarding reoperation rates and autograft function with time. RR without aRI was associated with significant adverse outcome. Therefore, surgical stabilization of the neo aortic root in the RR Ross procedure ought to be taken into consideration whenever possible.