Author + information
- Received May 16, 2017
- Revision received August 5, 2017
- Accepted August 14, 2017
- Published online October 2, 2017.
- Elisabeth Martin, MD, MPH,
- Siamak Mohammadi, MD,
- Frederic Jacques, MD,
- Dimitri Kalavrouziotis, MD,
- Pierre Voisine, MD,
- Daniel Doyle, MD and
- Jean Perron, MD∗ ()
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Jean Perron, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Division of Cardiac Surgery, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V 4G5, Canada.
Background Very few reports of long-term outcomes of patients who underwent the Ross procedure have been published.
Objectives The authors reviewed their 25-year experience with the Ross procedure with the aim of defining very–long-term survival and factors associated with Ross-related failure.
Methods Between January 1990 and December 2014, the Ross procedure was performed in 310 adults (mean age 40.8 years) at a single institution. All patients were prospectively added to a dedicated cardiac surgery registry. Complete post-operative clinical examination and history were obtained, and transthoracic echocardiography was performed according to a standardized protocol. There was no loss to follow-up. Median follow-up was 15.1 years and up to 25 years.
Results Bicuspid aortic valve was diagnosed in 227 patients (73.2%), and the most common indication for surgery was aortic stenosis (n = 225 [72.6%]). Freedom from any Ross-related reintervention was 92.9% and 70.1% at 10 and 20 years, respectively. Independent risk factors for pulmonary autograft degeneration were pre-operative large aortic annulus (hazard ratio: 1.1; p = 0.01), pre-operative aortic insufficiency (hazard ratio: 2.7; p = 0.002), and concomitant replacement of the ascending aorta (hazard ratio: 7.7; p = 0.0003). There were 4 hospital deaths (1.3%), and overall survival at 10 and 20 years was 94.1% and 83.6%, respectively. Long-term survival was not significantly different in patients who required Ross-related reintervention (log-rank p = 0.70). However, compared with the general population, survival was significantly lower in patients following the Ross procedure when matched on age and sex (p < 0.0001).
Conclusions The Ross procedure was associated with excellent long-term valvular outcomes and survival, regardless of the need for reintervention. Adults presenting with aortic insufficiency or a dilated aortic annulus or ascending aorta were at greater risk for reintervention. Unlike previous reports, long-term survival was lower in Ross patients compared with matched subjects.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 16, 2017.
- Revision received August 5, 2017.
- Accepted August 14, 2017.
- 2017 American College of Cardiology Foundation
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