Thorac Cardiovasc Surg 2012; 60 - V150
DOI: 10.1055/s-0031-1297540

Update on reinterventions 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: 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.