Major adverse cardiac and cerebrovascular events after the Ross procedure: a report from the German-Dutch Ross Registry

TY - JOUR

T1 - Major adverse cardiac and cerebrovascular events after the Ross procedure: a report from the German-Dutch Ross Registry

AU - Sievers, Hans-H

AU - Stierle, Ulrich

AU - Charitos, Efstratios I

AU - Hanke, Thorsten

AU - Misfeld, Martin

AU - Matthias Bechtel, J F

AU - Gorski, Armin

AU - Franke, Ulrich F W

AU - Graf, Bernhard

AU - Robinson, Derek R

AU - Bogers, Ad J J C

AU - Dodge-Khatami, Ali

AU - Boehm, Juergen O

AU - Rein, Joachim G

AU - Botha, Cornelius A

AU - Lange, Ruediger

AU - Hoerer, Juergen

AU - Moritz, Anton

AU - Wahlers, Thorsten

AU - Breuer, Martin

AU - Ferrari-Kuehne, Katharina

AU - Hetzer, Roland

AU - Huebler, Michael

AU - Ziemer, Gerhard

AU - Takkenberg, Johanna J M

AU - Hemmer, Wolfgang

AU - German-Dutch Ross Registry

PY - 2010/9/14

Y1 - 2010/9/14

N2 - BACKGROUND: The purpose of the study is to report major cardiac and cerebrovascular events after the Ross procedure in the large adult and pediatric population of the German-Dutch Ross registry. These data could provide an additional basis for discussions among physicians and a source of information for patients.METHODS AND RESULTS: One thousand six hundred twenty patients (1420 adults; 1211 male; mean age, 39.2±16.2 years) underwent a Ross procedure between 1988 and 2008. Follow-up was performed on an annual basis (median, 6.2 years; 10 747 patient-years). Early and late mortality were 1.2% (n=19) and 3.6% (n=58; 0.54%/patient-year), respectively. Ninety-three patients underwent 99 reinterventions on the autograft (0.92%/patient-year); 78 reinterventions in 63 patients on the pulmonary conduit were performed (0.73%/patient-year). Freedom from autograft or pulmonary conduit reoperation was 98.2%, 95.1%, and 89% at 1, 5, and 10 years, respectively. Preoperative aortic regurgitation and the root replacement technique without surgical autograft reinforcement were associated with a greater hazard for autograft reoperation. Major internal or external bleeding occurred in 17 (0.15%/patient-year), and a total of 38 patients had composite end point of thrombosis, embolism, or bleeding (0.35%/patient-year). Late endocarditis with medical (n=16) or surgical treatment (n=29) was observed in 38 patients (0.38%/patient-year). Freedom from any valve-related event was 94.9% at 1 year, 90.7% at 5 years, and 82.5% at 10 years.CONCLUSIONS: Although longer follow-up of patients who undergo Ross operation is needed, the present series confirms that the autograft procedure is a valid option to treat aortic valve disease in selected patients. The nonreinforced full root technique and preoperative aortic regurgitation are predictors for autograft failure and warrant further consideration. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00708409.

AB - BACKGROUND: The purpose of the study is to report major cardiac and cerebrovascular events after the Ross procedure in the large adult and pediatric population of the German-Dutch Ross registry. These data could provide an additional basis for discussions among physicians and a source of information for patients.METHODS AND RESULTS: One thousand six hundred twenty patients (1420 adults; 1211 male; mean age, 39.2±16.2 years) underwent a Ross procedure between 1988 and 2008. Follow-up was performed on an annual basis (median, 6.2 years; 10 747 patient-years). Early and late mortality were 1.2% (n=19) and 3.6% (n=58; 0.54%/patient-year), respectively. Ninety-three patients underwent 99 reinterventions on the autograft (0.92%/patient-year); 78 reinterventions in 63 patients on the pulmonary conduit were performed (0.73%/patient-year). Freedom from autograft or pulmonary conduit reoperation was 98.2%, 95.1%, and 89% at 1, 5, and 10 years, respectively. Preoperative aortic regurgitation and the root replacement technique without surgical autograft reinforcement were associated with a greater hazard for autograft reoperation. Major internal or external bleeding occurred in 17 (0.15%/patient-year), and a total of 38 patients had composite end point of thrombosis, embolism, or bleeding (0.35%/patient-year). Late endocarditis with medical (n=16) or surgical treatment (n=29) was observed in 38 patients (0.38%/patient-year). Freedom from any valve-related event was 94.9% at 1 year, 90.7% at 5 years, and 82.5% at 10 years.CONCLUSIONS: Although longer follow-up of patients who undergo Ross operation is needed, the present series confirms that the autograft procedure is a valid option to treat aortic valve disease in selected patients. The nonreinforced full root technique and preoperative aortic regurgitation are predictors for autograft failure and warrant further consideration. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00708409.

KW - Adult

KW - Aortic Valve/surgery

KW - Aortic Valve Insufficiency/mortality

KW - Endocarditis/etiology

KW - Female

KW - Follow-Up Studies

KW - Germany

KW - Hemorrhage/etiology

KW - Humans

KW - Male

KW - Middle Aged

KW - Netherlands

KW - Postoperative Complications/mortality

KW - Registries

KW - Transplantation, Autologous

U2 - 10.1161/CIRCULATIONAHA.109.925800

DO - 10.1161/CIRCULATIONAHA.109.925800

M3 - SCORING: Journal article

C2 - 20837916

VL - 122

SP - 216

EP - 223

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

IS - 11 Suppl

ER -