An Update on the Adult Patients of the German Ross Registry

Objectives: Conventional aortic valve replacement (AVR) in the young, active patient represents a suboptimal solution, in terms of long term survival, durability and quality of life. Aim of the present work is to present an update on the multicenter experience with the pulmonary autograft procedure in young adults patient undergoing aortic valve replacement.

Methods: Between 1992–2013, 1779 patients (1339 adults; 44.7 ± 11.6 years) underwent AVR with the pulmonary autograft principle in 9 centers. All patients underwent prospective clinical and echocardiographic examinations, annually. Mean follow-up was 8.3 ± 5.1 years (range 0–24.3) with a total cumulative follow-up of 14288 years with 662 patients having a follow-up of at least 10 years.

Results: Early (30 day) mortality was 1.1% (n = 19. Late (>30 day) survival of the adult population was comparable to the age and gender matched general population (observed deaths:101, expected deaths:91; p = 0.29). Freedom from autograft reoperation at 5, 10, and 15 years was 96.8%, 94.7% and 86.7% respectively whereas freedom from homograft reoperation was 97.6%, 95.5% and 92.3% respectively. Overall freedom from reoperation was 94.9%, 91.1% and 82.7% respectively. Longitudinal modeling of functional valve characteristics revealed a low (< 5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade.

Conclusion: For the young, active patient requiring aortic valve replacement, the autograft principle results in postoperative long-term survival comparable to that of the age and gender matched general population and reoperation rates within the 1% / patient*year boundaries. The autograft principle for the treatment of the aortic valve disease in young, active patients who want to avoid the shortcomings of conventional prostheses should be strongly considered.