Long-Term Outcomes of Patients Undergoing the Ross Procedure

Aboud, Anas; Charitos, Efstratios I.; Fujita, Buntaro; Stierle, Ulrich; Reil, Jan‐Christian; Voth, Vladimir; Liebrich, M.; Andreas, Martin; Holubec, Tomáš; Bening, C.; Albert, Marc; Fila, Petr; Ondrášek, Jiří; Muríň, Peter; Lange, Rüdiger; Reichenspurner, Hermann; Franke, Ulrich; Gorski, Armin; Moritz, Anton; Laufer, Günther; Hemmer, Wolfgang; Sievers, Hans‐Hinrich; Ensminger, Stephan

doi:10.1016/j.jacc.2021.01.034

Cited by 66 publications

(64 citation statements)

References 33 publications

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“…Whereas our cohort included 43% of patients with predominant AI (in which we aggressively used aortic annuloplasty), only 22% of the Aboud cohort had predominant AI, and 10% of the Romeo cohort had severe AI. Severe or predominant preoperative AI has been consistently shown to increase the risk for autograft reintervention (12,13,14,28). Indeed, we also previously reported that AI increases the risk for autograft reintervention (3) and thereafter adjusted our selection criteria.…”

Section: Discussionmentioning

confidence: 85%

“…Median follow-up was 9.2 years, with similar rates of in-hospital mortality and long-term survival as reported in our series. Aboud and colleagues reported on 2,444 adult patients undergoing the Ross procedure primarily in Germany (14). Median followup was again 9.2 years, and long-term survival was noninferior to an age-and sex-matched general population.…”

Section: Discussionmentioning

confidence: 99%

“…High-volume centers and surgeons have reported excellent short-, mid-, and long-term outcomes following the Ross procedure in adults, with recent reports published from Australia (7), Austria (8), Germany (9), and Canada (10)(11)(12). Two recent multi-center, international registry reports have confirmed and extended these findings (13,14). However, the Ross procedure accounts for less than 0.1% of all aortic valve replacements performed in the United States (15).…”

Section: Introductionmentioning

confidence: 95%

“…Estimates of freedom from all-cause mortality (with 95% CI) at 1-, 10-and 20-year were 97.8% (95.9-99.7%), 94.2% (91.0-97.4%), and 81.3% (74.8-88.3%), respectively. There were 24 late mortalities, after a median of 15 [9][10][11][12][13][14][15][16][17] years (Table 2). Three late deaths were from Ross-related causes: one from complications following redo SAVR performed outside our institution and two from endocarditis of the homograft.…”

Section: Long-term Survivalmentioning

confidence: 99%

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Long-term outcomes of the Ross procedure in adults

Ryan¹,

Squiers²,

Harrington³

et al. 2021

Ann Cardiothorac Surg

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Background: The optimal aortic valve replacement for young and middle-aged adults remains elusive.Although several high-volume international centers and surgeons have demonstrated excellent long-term results with the pulmonary autograft (Ross procedure) in adult patients, current guidelines from the United States do not favor this technique. We evaluated long-term clinical and echocardiographic outcomes of adult patients undergoing the Ross procedure at our center.Methods: A retrospective review of 225 consecutive adult patients undergoing the Ross procedure was completed. Kaplan-Meier analysis was performed to evaluate overall survival, which was then compared to an age-and sex-matched general population with the log-rank test. Accounting for death as a competing hazard, the cumulative incidence of reintervention and autograft or homograft dysfunction were estimated over the long-term.Results: Mean age was 42±11 years, and 62 (28%) patients were at least 50 years old. A bicuspid aortic valve was present in 179 (80%) patients. The most common indications for surgery were aortic insufficiency (n=94, 43%), aortic stenosis (n=81, 36%), and mixed etiology (n=46, 21%). In-hospital mortality was 0.9%.Overall survival (with 95% confidence intervals) at 1-, 10-and 20-year was 97.8% (95.9-99.7%), 94.2% (91.0-97.4%), and 81.3% (74.8-88.3%), respectively. Overall survival approximated that of the general population (log-rank P=0.32). The cumulative incidence (with 95% confidence intervals) of any autograft or homograft reintervention at 10-, 15-, and 20-year was 16% (12-20%), 28% (21-35%), and 45% (36-54%), respectively. Conclusions:The Ross procedure restores a normal life expectancy to young and middle-aged adults with severe aortic valve disease. The need for reintervention increases steadily during the second decade after the Ross procedure, but less than half of patients require any reintervention for up to 20-year.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

Section: Long-term Survivalmentioning

confidence: 99%

See 2 more Smart Citations

Long-term outcomes of the Ross procedure in adults

Ryan¹,

Squiers²,

Harrington³

et al. 2021

Ann Cardiothorac Surg

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“…In the most recent addition of the Journal of the American College of Cardiology, Aboud et al present the late results of 2,444 patients from the German Ross Registry who had undergone a Ross procedure. 3 This multicenter series reported a median follow-up period of 9.2 years (range 0 -27.4 years) and represents the largest published series of the Ross procedure to date. The mean age at operation was 44 +/-12 years and 63% had a bicuspid aortic valve.…”

mentioning

confidence: 93%

The Ross Procedure for Aortic Valve Disease: Radical or Routine?

Chu

Bainbridge

2021

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease

et al. 2023

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ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age &lt;65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.

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Long-Term Outcomes of Patients Undergoing the Ross Procedure

Cited by 66 publications

References 33 publications

Long-term outcomes of the Ross procedure in adults

Long-term outcomes of the Ross procedure in adults

The Ross Procedure for Aortic Valve Disease: Radical or Routine?

Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease

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