Redo aortic root surgery post-Ross procedure

Area of Science:

• Cardiac surgery
• Aortic valve disease
• Surgical outcomes

Background:

• The Ross procedure, while advantageous, carries risks of late autograft and right ventricular outflow tract conduit failure.
• Reoperations are necessary to address autograft dysfunction and conduit failure following the Ross procedure.

Purpose of the Study:

• To analyze the outcomes of reoperations for autograft dysfunction after the Ross procedure.
• To compare autograft-sparing procedures (VSP) with root replacement techniques (Bentall procedure).

Main Methods:

• A retrospective analysis of 49 patients who underwent redo aortic root surgery between 2015 and 2023.
• Patients were divided into two groups: autograft valve-sparing procedures (VSP) (n=20) and Bentall procedure (BP) (n=29).
• Clinical and echocardiographic outcomes were evaluated at mid-term follow-up.

Main Results:

• The early mortality rate was 2.0% with no significant difference between VSP and BP groups.
• Severe autograft insufficiency and patient age were associated with choosing valve replacement over VSP.
• At a median follow-up of 34 months, freedom from VSP failure was 93.8% and freedom from aortic prosthesis dysfunction was 94.1% in the respective groups. No late deaths or reoperations were reported.

Conclusions:

• Redo aortic root surgery is a safe and effective option for patients with autograft failure.
• Both root replacement and valve-sparing procedures yield acceptable mid-term results.
• Performing redo surgery early, before severe aortic insufficiency develops, enhances the potential for preserving the native autograft valve.