Results of the Ross procedure in adults: a single-centre experience of 741 operations

• Published in: European journal of cardio-thoracic surgery 2016-05, Vol.49 (5), p.e97-e104
• Main Authors: Karaskov, Alexander, Sharifulin, Ravil, Zheleznev, Sergey, Demin, Igor, Lenko, Evgeny, Bogachev-Prokophiev, Alexander
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Echocardiography; Female; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Heart Valve Prosthesis Implantation - statistics & numerical data; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezw047

OBJECTIVES Although the Ross procedure provides excellent long-term survival and a high quality of life, only a limited number of centres perform it as an alternative to the standard aortic valve replacement in adults. In the present study, we evaluated our 16-year results of using the Ross procedure in adult patients. METHODS Between 1998 and 2014, 741 adult patients underwent the Ross procedure. The mean patient age was 47.4 ± 12.8 years (range, 18–67 years). The total root replacement technique was used in all patients. Right ventricular outflow tract (RVOT) reconstruction was performed with pulmonary allograft in 175 (23.6%) patients, with different types of xenografts in 561 (75.7%) and with polytetrafluoroethylene conduits in 5 (0.7%) patients. RESULTS The early mortality rate was 3.0%. The mean follow-up duration was 5.8 ± 2.2 years. The survival rate at 10 years was 90.7% and was comparable with survival of an age- and sex-matched general population. The rate of freedom from autograft reoperations was 94.1 and 88.3% at 5 and 10 years, respectively. The aortic annulus dilatation was the only independent predictor of autograft failure. The 10-year freedom rates from reoperations for allograft, diepoxide- and glutaraldehyde-treated pericardial xenografts as well as porcine aortic root grafts were 100, 94.4, 82.7 and 80.6%, respectively. The use of xenografts and young patient age were associated with increased risk of RVOT conduit failure. CONCLUSIONS The Ross operation provides long-term survival rates that are comparable with an age- and gender-matched general population. The dilated aortic annulus is a risk factor for late autograft valve insufficiency. A cryopreserved pulmonary homograft is the best option for RVOT reconstruction. Diepoxide-treated pericardial xenografts can be an alternative to allografts in elderly patients when an allograft is not available.