The Ross procedure in adult patients: a single-centre analysis of long-term results up to 28 years.

Autor:	Oeser C; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Uyanik-Uenal K; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Kocher A; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Laufer G; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria., Andreas M; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2022 Jul 11; Vol. 62 (2).
DOI:	10.1093/ejcts/ezac379
Abstrakt:	Objectives: This study aimed to provide an in-depth insight into our single-centre experience with the Ross procedure. Methods: All adults who underwent the Ross procedure between 1991 and 2014 were included. Based on the total number of Ross procedures performed by each surgeon at our centre during this 24-year period, surgeon volume was classified as low (<25 procedures), intermediate (25-44 procedures) and high (≥45 procedures). Survival, complications and reinterventions were evaluated. A single cardiologist assessed the pulmonary autograft's function and the neoaortic root diameter by echocardiography. Results: The outcomes of 224 patients {176 men, 48 women; mean age 37.2 [standard deviation (SD) 10.0] years} were analysed. Patients operated on by a low-volume surgeon had 7.22 times higher odds (P < 0.001) for a serious adverse event during the intraoperative or early postoperative course than patients operated on by a high-volume surgeon. Early mortality was 1.8%. Overall survival was 87.3% at 20 years. Compared with the demographically matched general population, the patients' survival was significantly lower (P = 0.002). The cumulative incidence of autograft and right ventricular outflow tract conduit reintervention was 21.5% and 5.9% at 20 years, respectively. Patients with preoperative aortic regurgitation had 6.25 times the subdistribution hazard of autograft reintervention (Bonferroni-adjusted P = 0.042) and a higher neoaortic root z-score [1.37 (SD 2.04) vs 0.17 (SD 1.81), P = 0.004] than patients with aortic stenosis. In patients with preoperative aortic regurgitation, autograft wrapping (remnant aortic wall and/or Vicryl® mesh) was associated with a 74% reduction in the subdistribution hazard of autograft reintervention (Bonferroni-adjusted P = 0.002) and with a reduced incidence of neoaortic root dilatation (P = 0.037). Conclusions: The Ross procedure performed by a specialized surgeon provides very satisfying long-term results. The higher risk of autograft reintervention in preoperative aortic regurgitation may be counteracted by supporting the autograft. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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