European multicenter experience with valve-sparing reoperations after the Ross procedure

Aart Mookhoek, Laurent De Kerchove, Gebrine El Khoury, Timo Weimar, Giovanni Battista Luciani, Alessandro Mazzucco, Ad J.J.C. Bogers, Diana Aicher, Hans Joachim Schäfers, Efstratios I. Charitos, Ulrich Stierle, Johanna J.M. Takkenberg

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Background Autograft valve preservation at reoperation may conserve some of the advantages of the Ross procedure. However, results of long-term follow-up are lacking. In this retrospective multicenter study, we present our experience with valve-sparing reoperations after the Ross procedure, with a focus on long-term outcome. Methods A total of 86 patients from 6 European centers, who underwent valve-sparing reoperation after the Ross procedure between 1997 and 2013, were included in the study. Results Reoperation was performed a median of 9.1 years after the Ross procedure in patients with a median age of 38.4 years (interquartile range: 27.1-51.6 years). Preoperative severe autograft regurgitation (grade ≥3) was present in 46% of patients. In-hospital mortality was 1%. During a median follow-up of 4.3 years, 3 more patients died of noncardiac causes, resulting in a cumulative survival at 8 years of 89% (95% confidence interval: 65%-97%). Fifteen patients required a reintervention after valve-sparing reoperation, mostly owing to prolapse or retraction of autograft cusps. Freedom from reintervention was 76% (95% confidence interval: 57%-87%) at 8 years. The reintervention hazard was increased in patients who had isolated and/or severe aortic regurgitation at valve-sparing reoperation. In patients without reintervention after valve-sparing autograft reoperation (n = 63), severe aortic regurgitation was present in 3% at last follow-up. Conclusions Valve-sparing autograft reoperations after the Ross procedure carry a low operative risk, with acceptable reintervention rates in the first postoperative decade. Patients with isolated and/or severe autograft regurgitation have an increased hazard of reintervention after valve-sparing reoperation; for these patients, careful preoperative weighing of surgical options is required.

Original languageEnglish
Pages (from-to)1132-1137
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number5
Publication statusPublished - 1 Nov 2015

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Mookhoek, A., De Kerchove, L., El Khoury, G., Weimar, T., Luciani, G. B., Mazzucco, A., ... Takkenberg, J. J. M. (2015). European multicenter experience with valve-sparing reoperations after the Ross procedure. Journal of Thoracic and Cardiovascular Surgery, 150(5), 1132-1137.