Major adverse cardiac events after the Ross operation in 1606 patients: current status of the German-Dutch Ross registry with up to 19 years follow-up

Background: The Ross operation has reached the 5th decade with good long term results from the pioneer series. There is gaining concern however about autograft and allograft durability over time. Furthermore, reports about major adverse cardiac events (MACE) as required by the latest guidelines update, in a large Ross patient cohort are scarce in the literature. It was the aim of this study to report the MACE in patients being treated with the Ross procedure. Methods: 1606 patients (mean age 39.3±16.1, range 0.0 –70.5y), male=1202, female=404) underwent a Ross procedure with a mean follow-up of 5.4±3.9y (7817 pt years, range 0.1–18.7y). Data from the prospective German-Dutch Ross Registry with 12 participating centers were evaluated in accordance to the 2008 guidelines of reporting mortality and morbidity after cardiac valve interventions. Results: Follow-up was complete in 94.6%. All cause mortality was n=69 (4.3%, cardiac=40, 2.5%, unknown=1). Overall survival was 97.7% at 5y and 95.2% at 10y. Structural and non-structural autograft failure with the need of reoperation occurred in n=70 (4.4%), autograft endocarditis with reoperation was present in n=12 (0.8%) resulting in a freedom from autograft reoperation of 97,1% at 5y and 93.0 % at 10y (mean time to reoperation 6.1±4.72y, median 5.7y). Allograft failure with the need of reoperation occurred in n=56 (3.5%) with a freedom from allograft reoperation of 96.9% at 5y and 93.7% at 10y (mean time to reoperation 4,3±3.8y, median 2,6y). 10 valvuloplasties were included in these numbers. Freedom from autograft and allograft reoperation was 94.5% at 5y and 88.1% at 10y. Infective endocarditis (conservative or medically treated) occurred in n=45 (linearized occurrence rate 0.57%/patient-year), thrombotic and thromboembolic events (including transient ischemic attacks) were observed in n=38 (linearized occurrence rate 0.48%/patient-year). Conclusion: A low rate of MACE in the long term after the Ross operation was observed in the registry. The large cohort enables to define subsets of patients who could be at risk for autograft reoperation. Caution ought to be attended to allograft and autograft endocarditis, since almost one fifth of all reoperations were associated with infective endocarditis

Reoperations on the pulmonary autograft and pulmonary homograft after the Ross procedure: An update on the German Dutch Ross Registry

Objectives: Reinterventions after the Ross procedure are a concern for patients and treating physicians. The scope of the present report was to provide an update on the reinterventions observed in the large patient population of the German-Dutch Ross Registry. Patients and Methods: From 1988 to 2011, 2023 patients (age, 39.05 +/- 16.5 years; male patients, 1502; adults, 1642) underwent a Ross procedure in 13 centers. The mean follow-up was 7.1 +/- 4.6 years (range, 0-22 years; 13,168 patient-years). Results: In the adult population, 120 autograft reinterventions in 113 patients (1.03%/patient-year) and 76 homograft reinterventions in 67 patients (0.65%/patient-year) and, in the pediatric population, 14 autograft reinterventions in 13 patients (0.91%/patient-year) and 42 homograft reinterventions in 31 patients (2.72%/patient-year) were observed. Of the autograft and homograft reinterventions, 17.9% and 21.2% were performed because of endocarditis, respectively. The subcoronary technique in Conclusions: The autograft principle remains a valid option for young patients requiring aortic valve replacement. The risk of reoperation depends largely on the surgical technique used and the preoperative hemodynamics. Center experience and expertise also influence the long-term results. Adequate endocarditis prophylaxis might further reduce the need for reoperation. (J Thorac Cardiovasc Surg 2012; 144: 813-23