RSS-Feed abonnieren
DOI: 10.1055/s-0031-1297540
Update on reinterventions after the Ross procedure – Results of the German-Dutch Ross Registry
Introduction: Reinterventions after the Ross procedure remain a concern for patients as well as treating physicians. Aim of the present study was to provide an update on reinterventions after the Ross procedure in the large patient population of the German-Dutch Ross Registry
Methods: Between 1988 and 2011, 2023 patients (mean age 39.05±16.5, 1502 male, 1642 adults) underwent a Ross procedure in 13 centers. Mean follow-up was 7.1±4.6 years (range: 0–22 years, with a total of 13168 patient*years).
Results: 134 autograft reinterventions in 126 patients (6.2%, Linearized Occurrence Rate (LOR) 1.0%/patient*year) and 118 homograft reinterventions in 98 patients (4.8%, 0.89%/patient * year) were observed. 20% of the autograft and homograft reinterventions were performed of the ground of endocarditis. Freedom from autograft reintervention was 87% at 10 years and 83% at 12 years. The subcoronary technique in the adult population resulted in significantly superior autograft durability (freedom from autograft reintervention 91% at 10 years, 88% at 12 years, p<0.001). The root replacement technique without root reinforcement (HR: 3.0, 95% C.I. 1.8–4.9) as well as the presence of pure aortic insufficiency preoperatively (HR 2.6, 95% C.I 1.8–3.9) were statistically significant predictors for shorter time to reoperation. Freedom from homograft reoperation was 93% at 10 years and 91% at 12 years, with younger recipient and older donor age being significant predictors of shorter time to homograft reoperation.
Conclusions: The subcoronary Ross technique results in acceptable long term results after the Ross procedure. Adequate endocarditis prophylaxis may further reduce the need for reoperation. The high late failure rates of the root replacement technique warrants caution.