Abstract 13709: Ross Procedure in Adults: Is Reoperation a Real Concern?
Objectives: The aim is to assess long term results of the Ross procedure in adults and identify predictors of autograft reoperation in the second post-operative decade.
Methods: From July 1995 to October 2012, 263 patients (p) (mean age 42 ± 14 years; 72% male) underwent Ross procedure with the free-standing root technique, of which 250 had aortic annulus reinforcement. Preoperative aortic valve disease was as follows: 134 p had aortic stenosis (AS), 93 p aortic insufficiency (AI) and 35 p both. Twenty-one p (7.9%) had previous cardiac surgery and 56 p (21%) had combined procedures. EuroSCORE was 5.5 ± 0.7. P were prospectively followed with clinical and echocardiografic evaluations. Mean follow up was 7.5 ± 5.0 years (range 0-17) and 94% completed. Survival and freedom from autograft, homograft or any reoperation were analyzed by means of Kaplan Meier curves. Cox regression analysis was used to identify predictors of autograft reoperation.
Results: Early mortality was 2.6% (7 p) and late mortality was 4.9% (14 p), 6 p were valve related deaths. Survival at 13 years was 90% (95% CI, 83-94 %). Reoperation was required for 15 p: 1 p in the homograft, 10 p in the autograft, 3 p in both and 1 p in the mitral valve. Freedom from any reoperation at 13 years was 91% (95% CI, 82-95%). Freedom from homograft reoperation at 13 years was 96% (95% CI, 89-99%). Freedom from autograft reoperation at 13 years was 92% (95% CI, 83-97%). Among the 10 p who required autograft reoperation: 8 p had preoperative AI, 4 p had preoperative AS and 1 p had both. Freedom from autograft reoperation was not significantly different for p with preoperative AI (89% at 13 years) compared with p who had preoperative AS (99% at 13 years) or those with both (83% at 13 years), p=0.4. Other variables (sex, aortic/pulmonary mismatch and aortic annulus diameter) were not significantly associated with the need of autograft reoperation.
Conclusions: Despite its complexity and reoperation rate during the second post-operative decade, Ross procedure should be considered as a valid surgical option for aortic valve disease treatment in selected p. In our series, preoperative aortic valve disease, sex, aortic/pulmonary mismatch and aortic annulus diameter were not significantly associated with the need of autograft reoperation.
- © 2013 by American Heart Association, Inc.