The Journal of thoracic and cardiovascular surgery · 2024
Long-term results of patients undergoing the Ross procedure after a previous aortic valve surgery.
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Chauvette Vincent, Chaud German J, Laurin Charles, Marzouk Mohamed, Kalavrouziotis Dimitri, Mohammadi Siamak, Pibarot Philippe, Perron Jean
Аннотация
OBJECTIVES: To assess the long-term outcomes of patients undergoing a Ross procedure in the context of a redo aortic valve (AV) surgery.
METHODS: Prospectively collected data in all consecutive adults who underwent a Ross procedure were analyzed to compare the Ross procedure performed as a first surgery (RF) or as a redo surgery (RP).
RESULTS: Between 1990 and 2021, 395 Ross procedures were performed at our center (RF, n = 345; RP, n = 50). A 2:1 propensity score matching was performed (RF, n = 100; RP, n = 50). The overall median follow-up was 11.6 years (interquartile range, 5.0-21.8 years) and 100% complete. Mean survival at 20 years was 87 ± 12% in the RF group and 87 ± 8% in the RP group (P = .30). The cumulative incidence of autograft reintervention at 10 years and 20 years was 6 ± 3% and 21 ± 6%, respectively, in the RF group and 9 ± 5% and 25 ± 8%, respectively, in the RP group (P = .74). The AV gradient remained stable up to 20 years in both groups (P = .42). The size of the sinuses of Valsalva tended to increase over time in the RF group but remained stable in the RP group (P = .03).
CONCLUSIONS: The ross procedure after a previous sternotomy for AV surgery is safe and offers good long-term results. Patients undergoing redo AV intervention have similar results as patients undergoing a primary Ross procedure, perhaps with a lower risk of autograft dilatation.
METHODS: Prospectively collected data in all consecutive adults who underwent a Ross procedure were analyzed to compare the Ross procedure performed as a first surgery (RF) or as a redo surgery (RP).
RESULTS: Between 1990 and 2021, 395 Ross procedures were performed at our center (RF, n = 345; RP, n = 50). A 2:1 propensity score matching was performed (RF, n = 100; RP, n = 50). The overall median follow-up was 11.6 years (interquartile range, 5.0-21.8 years) and 100% complete. Mean survival at 20 years was 87 ± 12% in the RF group and 87 ± 8% in the RP group (P = .30). The cumulative incidence of autograft reintervention at 10 years and 20 years was 6 ± 3% and 21 ± 6%, respectively, in the RF group and 9 ± 5% and 25 ± 8%, respectively, in the RP group (P = .74). The AV gradient remained stable up to 20 years in both groups (P = .42). The size of the sinuses of Valsalva tended to increase over time in the RF group but remained stable in the RP group (P = .03).
CONCLUSIONS: The ross procedure after a previous sternotomy for AV surgery is safe and offers good long-term results. Patients undergoing redo AV intervention have similar results as patients undergoing a primary Ross procedure, perhaps with a lower risk of autograft dilatation.