The Ross procedure is a safe and durable option in adults with infective endocarditis: a multicentre study
| Autor: | Philippe Demers, Vincent Chauvette, Nancy Poirier, Ismail El-Hamamsy, Michael W.A. Chu, Mohammed Tarabzoni, Jean Perron, Marie-Ève Chamberland, Laurence Lefebvre, Ismail Bouhout |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Drug overdose Transplantation Autologous Drug user 03 medical and health sciences 0302 clinical medicine medicine Humans Endocarditis Cumulative incidence 030212 general & internal medicine Autografts Pulmonary Valve business.industry Ross procedure General Medicine Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Aortic Valve Infective endocarditis Concomitant Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 58:537-543 |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezaa078 |
| Popis: | OBJECTIVES Surgical treatment of infective endocarditis (IE) remains a challenge. The Ross procedure offers the benefit of a living substitute in the aortic position but it is a more complex operation which may lead to increased operative risk. The aim of this study was to assess the safety and late outcomes of the Ross procedure for the treatment of active IE. METHODS From 2000 to 2019, a total of 31 consecutive patients underwent a Ross procedure to treat active IE (mean age 43 ± 12 years, 84% male). All patients were followed up prospectively. Four patients (13%) were intravenous (IV) drug users and 6 patients (19%) had prosthetic IE. The most common infective organism was Streptococcus (58%). Median follow-up was 3.5 (0.9–4.5) years and 100% complete. RESULTS There were no in-hospital deaths. One patient suffered a postoperative stroke (3%) and 1 patient (3%) required reintervention for bleeding. Three patients had a new occurrence endocarditis: 2 patients were limited to the pulmonary homograft and successfully managed with IV antibiotics, whereas 1 IV drug user patient developed concomitant autograft and homograft endocarditis. Overall, cumulative incidence of IE recurrence was 13 ± 8% at 8 years. The cumulative incidence for autograft endocarditis was 5 ± 4% at 8 years. Two patients (6%) died during follow-up, both from drug overdoses. At 8 years, actuarial survival was 88 ± 8%. CONCLUSIONS In selected patients with IE, the Ross procedure is a safe and reasonable alternative with good mid-term outcomes. Freedom from recurrent infection on the pulmonary autograft is excellent, labelporting the notion that a living valve in the aortic position provides good resistance to infection. Nevertheless, in IV drug user patients, pulmonary homograft endocarditis remains a challenge. Continued follow-up is needed to ascertain the long-term benefits of this approach. |
| Databáze: | OpenAIRE |
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