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Autograft reoperations after the Ross procedure.

Karen B Abeln1, Tristan Ehrlich1, Idriss Souko1

  • 1Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 27, 2023
PubMed
Summary

Reoperations for failed autografts after the Ross procedure can preserve the valve in most cases. Valve-sparing reoperations offer excellent long-term survival and reduce the need for further interventions.

Keywords:
Autograft failurePulmonary autograft dilatationRoss procedureValve-sparing procedure

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Valve Surgery

Background:

  • Autograft failure can occur after the Ross procedure, necessitating reoperation.
  • Repairing the autograft during reoperation aims to maintain the benefits of the original Ross procedure.

Purpose of the Study:

  • To evaluate the mid-term outcomes of patients undergoing reoperation for a failed aortic autograft.
  • To assess the efficacy and safety of valve-sparing procedures in autograft reintervention.

Main Methods:

  • Retrospective analysis of 30 patients who underwent autograft reintervention between 1997 and 2022.
  • Procedures included valve repair, root replacement, or combined approaches; valve replacement was performed in a minority of cases.
  • Follow-up duration averaged 5.4 years, with a maximum of 24 years.

Main Results:

  • Most reoperations (26/30) were valve-sparing, including isolated valve repair or root replacement.
  • Freedom from cardiac death at 10 years was 96% for valve repair and 50% for replacement.
  • Freedom from autograft reintervention at 15 years was 95%, with only two patients requiring subsequent reoperation.

Conclusions:

  • Autograft reoperations after the Ross procedure can be successfully performed as valve-sparing procedures in the majority of patients.
  • Valve-sparing reoperations are associated with excellent long-term survival and freedom from reoperation.