Contemporary Ross procedure outcomes: medium- to long-term results in 214 patients

Abstract

OBJECTIVE Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate. METHODS We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997–2009) and era 2 (2010–2019). RESULTS Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15–38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148–202) and 202 (IQR 182–244) min. The median postoperative stay was 6 days (2–77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9–13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5–17.4) and 4.8 (IQR 2.5–7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation. CONCLUSIONS The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.

Survival and freedom from reoperation after the Ross procedure in a Russian adult population: A single-center experience

“…The rate of autograft reinterventions differs between studies, and common indications for reoperation include the neoaortic root dilatation, infective endocarditis, technical failures, and others. 6,8,11,12 In the current study, the freedom from reoperation for the autograft was 89.1% (95% CI, 81.2%-97.8%) at 11 years. The main causes of autograft reintervention were dilatation of the neoaortic root and the ascending aorta.…”

Reoperations after Ross procedure: a retrospective study

“…лярного соединения), предложенные для укрепления аутографта, уменьшат эту проблему в будущем [17]. Некоторые исследования показали обнадеживающие результаты модифицированных методик [12,13,18]. Реоперации же после модифицированной операции Росса понадобились 2 больным, у одного больного (после окутывания дакроновым протезом легочного аутографта) развился тромбоз легочного гомографта, у второго больного (после окутывания собственной аортой) развилась тяжелая АР.…”

“…There were no postoperative complications (perioperative myocardial infarction, acute kidney injury, stroke, sternal infection, cardiac tamponade) and deaths. The median length of stay in intensive care unit was 21 [16][17][18][19][20][21][22][23] hours.…”