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Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years.

Abstract

INTRODUCTION

The Ross procedure is an alternative to standard aortic valve (AV) replacement in young and middle-aged patients. However, durability and incidence of reoperation remain a concern for most cardiac surgeons. Our aim was to assess very long-term clinical and echocardiographic outcomes of the Ross procedure.

METHODS

We conducted a single-center retrospective analysis of 56 consecutive adult patients who underwent the Ross procedure. Mean age at surgery was 44±12 years (range, 16-65 years) and 55% were male. Clinical endpoints included overall mortality and the need for valve reoperation due to graft failure. The echocardiographic endpoint was the presence of any graft deterioration. Median clinical follow-up was 20 years (1120 patient/years).

RESULTS

Indications for surgery were dominant aortic stenosis in 50% and isolated aortic regurgitation in 21%. Concomitant mitral valve repair was performed in 21% and a subcoronary technique was most commonly used (86%). Overall long-term survival was 91%, 80% and 77% at 15, 20 and 24 years, respectively. The survival rate was similar to the age- and gender-matched general population (p=0.44). During the follow-up period, freedom from graft reoperation was 80%. Eleven patients (31%) developed moderate AV regurgitation, three (8.6%) developed moderate pulmonary regurgitation and one (2.9%) presented moderate pulmonary stenosis.

CONCLUSION

The Ross procedure, mostly using a subcoronary approach, proved to have good clinical and hemodynamic results, with low reoperation rates in long-term follow-up. Moderate autograft regurgitation was a frequent finding but had no significant clinical impact.

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  • Authors+Show Affiliations

    ,

    Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal. Electronic address: lg.sarita@gmail.com.

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    Cardiac Surgery Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    ,

    Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    ,

    Cardiac Surgery Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    ,

    Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    ,

    Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    ,

    Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    ,

    Cardiac Surgery Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    Cardiology Department, Hospital de Santa Cruz, Carnaxide, Portugal.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng por

    PubMed ID

    31221488

    Citation

    Guerreiro, Sara, et al. "Long-term Assessment of the Ross Procedure in Adults: Clinical and Echocardiographic Follow-up at 20 Years." Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, vol. 38, no. 5, 2019, pp. 315-321.
    Guerreiro S, Madeira M, Ribeiras R, et al. Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years. Rev Port Cardiol. 2019;38(5):315-321.
    Guerreiro, S., Madeira, M., Ribeiras, R., Queiroz E Melo, J., Canada, M., Horta, E., ... Mendes, M. (2019). Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years. Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology, 38(5), pp. 315-321. doi:10.1016/j.repc.2018.06.014.
    Guerreiro S, et al. Long-term Assessment of the Ross Procedure in Adults: Clinical and Echocardiographic Follow-up at 20 Years. Rev Port Cardiol. 2019;38(5):315-321. PubMed PMID: 31221488.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years. AU - Guerreiro,Sara, AU - Madeira,Márcio, AU - Ribeiras,Regina, AU - Queiroz E Melo,João, AU - Canada,Manuel, AU - Horta,Eduarda, AU - Reis,Carla, AU - Neves,José Pedro, AU - Mendes,Miguel, Y1 - 2019/06/17/ PY - 2018/01/14/received PY - 2018/04/18/revised PY - 2018/06/13/accepted PY - 2019/6/22/pubmed PY - 2019/6/22/medline PY - 2019/6/22/entrez KW - Aortic valve replacement KW - Cirurgia de Ross KW - Long-term outcome KW - Ross procedure KW - Seguimento a longo prazo KW - Substituição da válvula aórtica SP - 315 EP - 321 JF - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology JO - Rev Port Cardiol VL - 38 IS - 5 N2 - INTRODUCTION: The Ross procedure is an alternative to standard aortic valve (AV) replacement in young and middle-aged patients. However, durability and incidence of reoperation remain a concern for most cardiac surgeons. Our aim was to assess very long-term clinical and echocardiographic outcomes of the Ross procedure. METHODS: We conducted a single-center retrospective analysis of 56 consecutive adult patients who underwent the Ross procedure. Mean age at surgery was 44±12 years (range, 16-65 years) and 55% were male. Clinical endpoints included overall mortality and the need for valve reoperation due to graft failure. The echocardiographic endpoint was the presence of any graft deterioration. Median clinical follow-up was 20 years (1120 patient/years). RESULTS: Indications for surgery were dominant aortic stenosis in 50% and isolated aortic regurgitation in 21%. Concomitant mitral valve repair was performed in 21% and a subcoronary technique was most commonly used (86%). Overall long-term survival was 91%, 80% and 77% at 15, 20 and 24 years, respectively. The survival rate was similar to the age- and gender-matched general population (p=0.44). During the follow-up period, freedom from graft reoperation was 80%. Eleven patients (31%) developed moderate AV regurgitation, three (8.6%) developed moderate pulmonary regurgitation and one (2.9%) presented moderate pulmonary stenosis. CONCLUSION: The Ross procedure, mostly using a subcoronary approach, proved to have good clinical and hemodynamic results, with low reoperation rates in long-term follow-up. Moderate autograft regurgitation was a frequent finding but had no significant clinical impact. SN - 2174-2030 UR - https://www.unboundmedicine.com/medline/citation/31221488/Long-term_assessment_of_the_Ross_procedure_in_adults:_Clinical_and_echocardiographic_follow-up_at_20_years L2 - https://linkinghub.elsevier.com/retrieve/pii/S0870-2551(18)30031-3 DB - PRIME DP - Unbound Medicine ER -