Long-Term Outcomes of Patients Undergoing the Ross Procedure.

Autor:	Aboud A; Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Lübeck, Germany. Electronic address: Anas.Aboud@uksh.de., Charitos EI; Department of Cardiac Surgery, University of Bonn, Bonn, Germany., Fujita B; Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Lübeck, Germany., Stierle U; Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany., Reil JC; Department of Cardiology, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany., Voth V; Sana Cardiac Surgery Stuttgart, Stuttgart, Germany., Liebrich M; Sana Cardiac Surgery Stuttgart, Stuttgart, Germany., Andreas M; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Holubec T; Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany., Bening C; Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany., Albert M; Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany., Fila P; Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic., Ondrasek J; Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic., Murin P; Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center, Berlin, Germany., Lange R; Department of Cardiovascular Surgery, German Heart Center, Munich, Germany., Reichenspurner H; Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany., Franke U; Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany., Gorski A; Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany., Moritz A; Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany., Laufer G; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Hemmer W; Sana Cardiac Surgery Stuttgart, Stuttgart, Germany., Sievers HH; Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany., Ensminger S; Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Lübeck, Germany.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Mar 23; Vol. 77 (11), pp. 1412-1422.
DOI:	10.1016/j.jacc.2021.01.034
Abstrakt:	Background: Treatment of aortic-valve disease in young patients still poses challenges. The Ross procedure offers several potential advantages that may translate to improved long-term outcomes. Objectives: This study reports long-term outcomes after the Ross procedure. Methods: Adult patients who were included in the Ross Registry between 1988 and 2018 were analyzed. Endpoints were overall survival, reintervention, and major adverse events at maximum follow-up. Multivariable regression analyses were performed to identify risk factors for survival and the need of Ross-related reintervention. Results: There were 2,444 adult patients with a mean age of 44.1 ± 11.7 years identified. Early mortality was 1.0%. Estimated survival after 25 years was 75.8% and did not statistically differ from the general population (p = 0.189). The risk for autograft reintervention was 0.69% per patient-year and 0.62% per patient-year for right-ventricular outflow tract (RVOT) reintervention. Larger aortic annulus diameter (hazard ratio [HR]: 1.12/mm; 95% confidence interval [CI]: 1.05 to 1.19/mm; p < 0.001) and pre-operative presence of pure aortic insufficiency (HR: 1.74; 95% CI: 1.13 to 2.68; p = 0.01) were independent predictors for autograft reintervention, whereas the use of a biological valve (HR: 8.09; 95% CI: 5.01 to 13.08; p < 0.001) and patient age (HR: 0.97 per year; 95% CI: 0.96 to 0.99; p = 0.001) were independent predictors for RVOT reintervention. Major bleeding, valve thrombosis, permanent stroke, and endocarditis occurred with an incidence of 0.15% per patient-year, 0.07% per patient-year, 0.13%, and 0.36% per patient-year, respectively. Conclusions: The Ross procedure provides excellent survival over a follow-up period of up to 25 years. The rates of reintervention, anticoagulation-related morbidity, and endocarditis were very low. This procedure should therefore be considered as a very suitable treatment option in young patients suffering from aortic-valve disease. (Long-Term Follow-up After the Autograft Aortic Valve Procedure [Ross Operation]; NCT00708409). Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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