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DOI: 10.1055/s-0031-1297492
Impact of endocarditis after the Ross procedure – Results of the German Dutch Ross Registry
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.