Major Adverse Cardiac and Cerebrovascular Events After the Ross Procedure A Report From the German-Dutch Ross Registry

HH Sievers, U Stierle, EI Charitos, T Hanke, M Misfeld, JFM Bechtel, A Gorski, UFW Franke, B Graf, DR Robinson, Ad Bogers, A Dodge-Khatami, JO Boehm, JG Rein, CA Botha, R Lange, J Hoerer, A Moritz, T Wahlers, M BreuerK Ferrari-Kuehne, R Hetzer, M Huebler, G Ziemer, Hanneke Takkenberg, W Hemmer

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Abstract

Background-The purpose of the study is to report major cardiac and cerebrovascular events after the Ross procedure in the large adult and pediatric population of the German-Dutch Ross registry. These data could provide an additional basis for discussions among physicians and a source of information for patients. Methods and Results-One thousand six hundred twenty patients (1420 adults; 1211 male; mean age, 39.2+/-16.2 years) underwent a Ross procedure between 1988 and 2008. Follow-up was performed on an annual basis (median, 6.2 years; 10 747 patient-years). Early and late mortality were 1.2% (n=19) and 3.6% (n=58; 0.54%/patient-year), respectively. Ninety-three patients underwent 99 reinterventions on the autograft (0.92%/patient-year); 78 reinterventions in 63 patients on the pulmonary conduit were performed (0.73%/patient-year). Freedom from autograft or pulmonary conduit reoperation was 98.2%, 95.1%, and 89% at 1, 5, and 10 years, respectively. Preoperative aortic regurgitation and the root replacement technique without surgical autograft reinforcement were associated with a greater hazard for autograft reoperation. Major internal or external bleeding occurred in 17 (0.15%/patient-year), and a total of 38 patients had composite end point of thrombosis, embolism, or bleeding (0.35%/patient-year). Late endocarditis with medical (n=16) or surgical treatment (n=29) was observed in 38 patients (0.38%/patient-year). Freedom from any valve-related event was 94.9% at 1 year, 90.7% at 5 years, and 82.5% at 10 years. Conclusions-Although longer follow-up of patients who undergo Ross operation is needed, the present series confirms that the autograft procedure is a valid option to treat aortic valve disease in selected patients. The nonreinforced full root technique and preoperative aortic regurgitation are predictors for autograft failure and warrant further consideration.
Original languageUndefined/Unknown
Pages (from-to)S216-S223
JournalCirculation
Volume122
Issue number11
DOIs
Publication statusPublished - 2010

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