Thorac Cardiovasc Surg 2012; 60 - V102
DOI: 10.1055/s-0031-1297492

Impact of endocarditis after the Ross procedure – Results of the German Dutch Ross Registry

EI Charitos 1, T Hanke 1, U Stierle 1, AW Gorski 2, WB Hemmer 3, CA Botha 4, UFW Franke 5, A Dodge-Khatami 6, R Lange 7, J Hoerer 7, A Moritz 8, K Ferrari-Kühne 9, R Hetzer 10, M Hübler 10, AJJC Bogers 11, JJM Takkenberg 11 HH Sievers 1, on behalf of the German-Dutch Ross Registry
  • 1Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
  • 2Klinik und Poliklinik für Thorax-, Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
  • 3Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
  • 4Herz-Zentrum Bodensee, Konstanz, Germany
  • 5Klinik für Herz- und Gefäßchirurgie, Robert Bosch Krankenhaus, Stuttgart, Germany
  • 6Universitäres Herzzentrum Hamburg, Hamburg, Germany
  • 7Deutsches Herzzentrum München, München, Germany
  • 8Klinik für Thorax-, Herz- und thorakale Gefäßchirurgie, Frankfurt/Main, Germany
  • 9Klinik für Chirurgie, Universitätsklinikum Jena, Herz- und Thoraxchirurgie, Jena, Germany
  • 10Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
  • 11Erasmus Medical Center, Rotterdam, Netherlands

Introduction: Autograft and homograft endocarditis remain a concern after the Ross procedure. Aim of the present study was to identify the incidence and characteristics of autograft and homograft endocarditis in the adult population of the German-Dutch Ross Registry.

Methods: Between 1988 and 2011, 1642 adult patients (mean age 43.5±11.9, 1223 male) underwent a Ross procedure in 13 centers. Mean follow-up was 7.1±4.5 years (range: 0–22 years, with a total of 11625 patient*years). All episodes of medically or surgically treated episodes of autograft or homograft were analysed.

Results: 9 episodes in 9 patients (Linearized Occurrence Rate (LOR) 0.07%/patient*year) and 13 episodes in 11 patients (LOR 0.11%/patient*year) of medically treated autograft and homograft endocarditis were reported. 85% of all these episodes could be successfully treated, without the need for surgical intervention. 26 surgical interventions in 25 patients (LOR 0.21%/patient*year) and 17 surgical interventions in 16 patients (LOR 0.14%/patient*year) were required due to autograft and homograft endocarditis respectively. Autograft or homograft endocarditis was the primary cause for 22% of all homograft or autograft surgical interventions observed in this patient population. Freedom from autograft or homograft endocarditis was 96% at 10 years and 94% at 15 years.

Conclusions: Although low in incidence, endocarditis after the Ross procedure results in considerable morbidity and is responsible for a fifth of surgical reinterventions on Ross related valves. Adequate prophylaxis combined with high clinical suspicion should be advised to further improve outcomes after the Ross procedure.