1158 Autograft degeneration, clinical outcomes and predictors after 21 years follow up in Ross procedure. A single center experience. (17th January 2020)

• Record Type: Journal Article
• Authors: Pericet Rodriguez, C; Pardo Gonzalez, L; Fernandez Ruiz, A; Gonzalez Manzanares, R; Ruiz Ortiz, M; Delgado Ortega, M; Rodriguez Almodovar, A; Carnero Montoro, L; Luque Moreno, A; Oneto Fernandez, M J; Paredes Hurtado, N; Villalba Montoro, R; Casares Mediavilla, J; Pan Alvarez-Ossorio, M; Mesa Rubio, D
• Is Part Of: European heart journal. Volume 21(2020)Supplement 1
• Publication Date: 2020-01-17
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jez319.662
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Background: Autograft regurgitation and the need of autograft reintervention are possible complications of Ross procedure. Purpose: Our Aim was to identify rates of autograft degeneration, reintervention and predictive factors valvular disease in a prospective series of a reference cardiovascular surgery hospital. Methods: Since November 1997 to July 2009, a total of 107 patients diagnosed of aortic valvular disease requiring surgical treatment underwent Ross surgery (mean age 30 ± 11 years, 69% male, 21 patients <18 years). In all of them, a comprehensive clinical and echocardiographic evaluation was performed before the intervention and at discharge, at 6, 12 months and annually after surgery. Results: At the end of follow-up (21 years, median: 17 years, interquartile rank 12-19 years), echocardiographic and clinical data were available in 95 (89%) and 105 (98%) patients, respectively. 30 patients (32%) developed at least moderate aortic regurgitation and 18 of them (17%) required autograft reintervention. Probability of survival free from at least moderate autograft regurgitation and reintervention at the end of follow up was 71% and 83% respectively. Two patients died because of reintervention related complications. A larger native pulmonary annulus size was the only factor, associated to autograft reintervention (HR 1.24 95% [CI] 1.04-1.48, p = 0.01) and at least moderate autograft regurgitation (HR 1.19 95% [CI] 1.03-1.37, p = 0.02). Autograft reintervention was also associated to intervention in the learning curve period (first 12 cases, HR 3.78, [CI] 95% 1.42-10.08, p = 0.008). We found no significant association of these outcomes with previous cardiac surgery, age, sex, aetiology of aortic lesion or native aortic annulus diameter. Conclusion: At long term follow-up after Ross procedure, 32% of patients developed at least moderate autograft regurgitation and 17% required autograft reintervention. A larger size of the native pulmonary annulus and intervention in the learning curve period were associated with the need of autograft surgery in the long term follow up.