A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry

OBJECTIVES Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure i...

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Published in:European journal of cardio-thoracic surgery 2016-01, Vol.49 (1), p.212-218
Main Authors: Sievers, Hans-Hinrich, Stierle, Ulrich, Charitos, Efstratios I., Takkenberg, Johanna J.M., Hörer, Jürgen, Lange, Rüdiger, Franke, Ulrich, Albert, Marc, Gorski, Armin, Leyh, Rainer G., Riso, Arlindo, Sachweh, Jörg, Moritz, Anton, Hetzer, Roland, Hemmer, Wolfgang
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aortic Valve Insufficiency - mortality
Aortic Valve Insufficiency - surgery
Aortic Valve Stenosis - mortality
Aortic Valve Stenosis - surgery
Female
Follow-Up Studies
Germany
Humans
Male
Middle Aged
Prospective Studies
Pulmonary Valve - transplantation
Registries
Survival Analysis
Transplantation, Autologous
Treatment Outcome
Young Adult
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Summary:OBJECTIVES Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients. METHODS Between 1990–2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0–24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years. RESULTS The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezv001