A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry

Sievers, Hans‐Hinrich; Stierle, Ulrich; Charitos, Efstratios I.; Takkenberg, Johanna J.M.; Hörer, Jürgen; Lange, Rüdiger; Franke, Ulrich; Albert, Marc; Gorski, Armin; Leyh, Rainer; Riso, Arlindo; Sachweh, Jörg S; Moritz, Anton; Hetzer, Roland; Hemmer, Wolfgang

doi:10.1093/ejcts/ezv001

Cited by 116 publications

(121 citation statements)

References 24 publications

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“…Supporting this position, several contemporary series have reported a rate of reintervention (for the pulmonary autograft and/or pulmonary homograft) ranging between 0.5% and 1.5% per patient-year, yielding a freedom from reintervention of 85% to 95% at 10 years. 6,8,18,28,29 In this series, the freedom from any surgical or percutaneous valve reintervention after the Ross procedure was 87% at 20 years and was better than our previously published results, 7 reflecting the more contemporary cohort in the present study.…”

Section: Reinterventioncontrasting

confidence: 43%

Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement

et al. 2016

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BACKGROUND:The ideal aortic valve substitute in young and middle-aged adults remains unknown. We sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving a mechanical aortic valve replacement (AVR). METHODS:From 1990 to 2014, 258 patients underwent a Ross procedure and 1444 had a mechanical AVR at a single institution. Patients were matched into 208 pairs through the use of a propensity score. Mean age was 37.2±10.2 years, and 63% were male. Mean follow-up was 14.2±6.5 years. RESULTS:Overall survival was equivalent (Ross versus AVR: hazard ratio, 0.91, 95% confidence interval, 0.38-2.16; P=0.83), although freedom from cardiac-and valve-related mortality was improved in the Ross group (Ross versus AVR: hazard ratio, 0.22; 95% confidence interval, 0.034-0.86; P=0.03). Freedom from reintervention was equivalent after both procedures (Ross versus AVR: hazard ratio, 1.86; 95% confidence interval, 0. 76-4.94; P=0.18). Long-term freedom from stroke or major bleeding was superior after the Ross procedure (Ross versus AVR: hazard ratio, 0.09; 95% confidence interval, 0.02-0.31; P<0.001).CONCLUSIONS: Long-term survival and freedom from reintervention were comparable between the Ross procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiacand valve-related mortality and a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR. long-term Outcomes of the ross Procedure Versus Mechanical aortic Valve replacementPropensity-Matched cohort study © 2016 American Heart Association, Inc.Key Words: aortic valve ◼ propensity score ◼ surgery ◼ treatment outcome ORIGINAL RESEARCH ARTICLE 577 Y oung and middle-aged adults with diseased aortic valves constitute a challenging population. Because of their longer anticipated life expectancy, these patients present a higher cumulative lifetime risk of prosthesis-related complications. The ideal aortic valve substitute in this patient population should allow improved survival, avoidance of reoperation and prosthesis-related complications, and maintenance of an active lifestyle with a good quality of life.As a result of their proven durability and ease of implantation, mechanical prostheses have long been the most frequently used option for aortic valve replacement (AVR) in young and middle-aged adults. However, recent reports suggest an excess in long-term mortality in young patients who undergo mechanical AVR compared with the age-and sex-matched general population.1,2 In addition, for female patients of childbearing age, mechanical prostheses are associated with an increased risk of thromboembolic events and warfarin-associated fetal malformations. 3,4 The Ross procedure (pulmonary autograft replacement) alleviates the need for lifelong anticoagulation. It allows the replacement of the diseased aortic valve with a living substitute, 5 th...

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Section: Reinterventioncontrasting

confidence: 43%

Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement

et al. 2016

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“…Importantly, SAVR also makes possible a variety of complex reparative procedures, such as associated atrial fibrillation ablation procedures and implantation of a variety of prostheses ranging from human allografts (“homografts”) to current‐generation tissue valves and mechanical prostheses. Furthermore, the pulmonary autograft operation may restore the patient to the expected survival curve for an age‐matched population . Arguably, the decision between prosthetic options, including both tissue and mechanical valves, should be presented first because TAVR restricts one to a tissue option.…”

Section: Criteria For Establishing a Tavr Program And Maintenance Of mentioning

confidence: 99%

2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement

Bavaria

Tommaso

Brindis

et al. 2019

Cathet Cardio Intervent

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“…In addition to the fact that the Ross procedure requires intervention on two valves to address a single-valve disease, the main concerns relate to its technical complexity and associated operative risk, as well as the risk of late autograft root dilatation requiring reintervention. Nevertheless, a number of long-term studies have emerged in the last decade, warranting a reevaluation of the role of the Ross procedure in today's armamentarium (12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Currently Available Surgical Optionsmentioning

confidence: 99%

The Ross procedure: time for a hard look at current practices and a reexamination of the guidelines

El-Hamamsy

Bouhout

2017

Ann. Transl. Med.

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The ideal aortic valve substitute for young adults requiring aortic valve replacement (AVR) remains elusive. Young and middle-aged patients have a longer anticipated life expectancy and a higher level of physical activity than their elderly counterparts. In recent years, there has been a growing focus on long-term outcomes following AVR in this specific patient population. These studies highlight the direct impact of the choice of prosthesis on long-term survival, quality of life and rates of valve-related complications in younger adults. Although conventional AVR using a biological or mechanical prosthesis significantly improve the natural history of the disease, there are many inherent limitations, which need to be addressed. Despite declining use of the Ross procedure in recent years, several long-term registry, cohort and comparative studies in the last decade, indicate a clear role for this operation in young and middle-aged adults requiring AVR. These advantages are manifest in terms of long-term survival, freedom from valve-related complications and quality of life. In this Perspective article, we discuss findings from a recently published propensity-matched analysis of long-term outcomes following mechanical AVR versus the Ross procedure, showing better cardiac- and valve-related survival in the Ross cohort, lower rates of stroke and major bleeding and equal rates of reoperation at 20 years. These data are placed in the broader context of currently available evidence regarding the Ross procedure and a broader discussion pertaining to its role in today's practice and the need to reexamine current valvular guidelines so they are more reflective of the actual evidence.

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A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry

Cited by 116 publications

References 24 publications

Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement

Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement

2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement

The Ross procedure: time for a hard look at current practices and a reexamination of the guidelines

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