Ross operation after failure of aortic valve repair.

Content Provider	Europe PMC
Author	Abeln, Karen B. Chauvette, Vincent Poirier, Nancy Matsushima, Shunsuke El-Hamamsy, Ismail Schäfers, Hans-Joachim
Copyright Year	2021
Abstract	Background Repair failure remains one of the most important complications of aortic valve reconstruction. Young patients might benefit from a Ross procedure in such a scenario, provided it can be performed safely and with adequate durability. The aim of this study was to assess the safety and clinical outcomes of a Ross operation following a failed repair. Methods Between 1996 and 2019, 80 patients (male, 76%; mean age, 31±13 years) underwent a Ross procedure after a median of 6.6 (1.7–15.9) years following an initial aortic valve repair. The previous valve repair was performed for unicuspid (53%), bicuspid (39%), tricuspid (7%), and quadricuspid morphology (1%). Median follow-up after the Ross operation was 2.8 (0.964–13.25) years, mean 5±5 years (92% complete). Results Median cardiopulmonary bypass and cross-clamp times were 144 [106–154] minutes and 98 [79–113] minutes, respectively. Thirty-two patients (40%) required a concomitant procedure, most commonly, an ascending aortic replacement (n=23). There were no peri-operative deaths, myocardial infarctions, or neurological complications. There was one late death from a non-cardiac cause. At 10 years, overall survival was 99%±1%, similar to that of an age- and gender-matched population. Nine patients required re-intervention after their Ross procedure (five on the autograft and four on the pulmonary conduit). The autograft re-interventions were valve-sparing procedures in all patients. The cumulative incidence of re-intervention on the autograft at 8 years was 5.1%±3.1%. Conclusions The stepwise strategy of an initial valve repair followed by Ross operation represents a safe and valid option for failed aortic valve repair. It is associated with low peri-operative morbidity. Mid-term survival is excellent, similar to that of a matched general population. The probability of re-intervention after the Ross procedure appears similar to that of a primary Ross operation, deeming it a warranted consideration in cases of failed aortic valve repair.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC8339625&blobtype=pdf
ISSN	2225319X
Volume Number	10
DOI	10.21037/acs-2020-rp-19
PubMed Central reference number	PMC8339625
Issue Number	4
PubMed reference number	34422559
Journal	Annals of Cardiothoracic Surgery [Ann Cardiothorac Surg]
e-ISSN	23041021
Language	English
Publisher	AME Publishing Company
Publisher Date	2021-07-01
Access Restriction	Open
Rights License	2021 Annals of Cardiothoracic Surgery. All rights reserved.
Subject Keyword	Ross procedure aortic valve repair aortic regurgitation (AR) aortic valve repair failure aortic valve replacement (AVR)
Content Type	Text
Resource Type	Article
Subject	Surgery Cardiology and Cardiovascular Medicine