TY - JOUR
T1 - Long-term clinical and echocardiographic outcomes in young and middle-aged adults undergoing the Ross procedure
AU - Romeo, Jamie L. R.
AU - Papageorgiou, Grigorios
AU - Costa, Francisco F. D. da
AU - Sievers, Hans H.
AU - Bogers, Ad J. J. C.
AU - el-Hamamsy, Ismail
AU - Skillington, Peter D.
AU - Wynne, Rochelle
AU - Mastrobuoni, Stefano
AU - El Khoury, Gebrine
AU - Takkenberg, Johanna J. M.
AU - Mokhles, Mostafa M.
PY - 2021
Y1 - 2021
N2 - IMPORTANCE There is no ideal valve substitute for young adults requiring aortic valve replacement. Multicenter data supporting use of the Ross procedure with respect to long-term postoperative valve–related mortality and reintervention, as well as function of the autograft and pulmonary homograft, are needed. OBJECTIVE To determine the long-term clinical and echocardiographic outcomes in young and middle-aged patients undergoing the Ross procedure. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter international cohort study with a median follow-up period of 9.2 years was conducted in 5 experienced centers regularly performing the Ross procedure. Consecutive patients aged 18 to 65 years were included by each center between 1991 and 2018. MAIN OUTCOMES AND MEASURES Survival and autograft-related and homograft-related reintervention. Serial echocardiographic measurements of valve function were analyzed using mixed-effects modeling. RESULTS During the study period, 1431 patients (74.3% men; n = 1063) were operated on at a median age of 48.5 years (mean [SD], 47.7 [9.5]; range, 18.1-65; interquartile range, 42.7-54.0). Implantation techniques were root inclusion in 355 (24.9%), root replacement in 485 (34.0%), and subcoronary implantation in 587 (41.1%). Right ventricular outflow tract reconstruction was performed with homografts in 98.6% (n = 1189) and bioprostheses in 1.4% (n = 17). Ten patients (0.7%) died before discharge. Median follow-up was 9.2 years (13 015 total patient-years). Survival after 10 and 15 years was 95.1% (95% CI, 93.8%-96.5%) and 88.5% (95% CI, 85.9%-91.1%), respectively. Freedom from autograft and homograft reintervention after 15 years was 92.0% and 97.2%, respectively. Late events were autograft endocarditis in 14 patients (0.11% per patient-year), homograft endocarditis in 11 patients (0.08% per patient-year), and stroke in 37 patients (0.3% per patient-year). CONCLUSIONS AND RELEVANCE Given its excellent short-term and long-term outcome in young and middle-aged adults in this study, the Ross procedure should be considered in young and middle-aged adults who require aortic valve replacement. Patients should be referred to an experienced center with a program dedicated to the Ross procedure.
AB - IMPORTANCE There is no ideal valve substitute for young adults requiring aortic valve replacement. Multicenter data supporting use of the Ross procedure with respect to long-term postoperative valve–related mortality and reintervention, as well as function of the autograft and pulmonary homograft, are needed. OBJECTIVE To determine the long-term clinical and echocardiographic outcomes in young and middle-aged patients undergoing the Ross procedure. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter international cohort study with a median follow-up period of 9.2 years was conducted in 5 experienced centers regularly performing the Ross procedure. Consecutive patients aged 18 to 65 years were included by each center between 1991 and 2018. MAIN OUTCOMES AND MEASURES Survival and autograft-related and homograft-related reintervention. Serial echocardiographic measurements of valve function were analyzed using mixed-effects modeling. RESULTS During the study period, 1431 patients (74.3% men; n = 1063) were operated on at a median age of 48.5 years (mean [SD], 47.7 [9.5]; range, 18.1-65; interquartile range, 42.7-54.0). Implantation techniques were root inclusion in 355 (24.9%), root replacement in 485 (34.0%), and subcoronary implantation in 587 (41.1%). Right ventricular outflow tract reconstruction was performed with homografts in 98.6% (n = 1189) and bioprostheses in 1.4% (n = 17). Ten patients (0.7%) died before discharge. Median follow-up was 9.2 years (13 015 total patient-years). Survival after 10 and 15 years was 95.1% (95% CI, 93.8%-96.5%) and 88.5% (95% CI, 85.9%-91.1%), respectively. Freedom from autograft and homograft reintervention after 15 years was 92.0% and 97.2%, respectively. Late events were autograft endocarditis in 14 patients (0.11% per patient-year), homograft endocarditis in 11 patients (0.08% per patient-year), and stroke in 37 patients (0.3% per patient-year). CONCLUSIONS AND RELEVANCE Given its excellent short-term and long-term outcome in young and middle-aged adults in this study, the Ross procedure should be considered in young and middle-aged adults who require aortic valve replacement. Patients should be referred to an experienced center with a program dedicated to the Ross procedure.
UR - https://hdl.handle.net/1959.7/uws:60772
U2 - 10.1001/jamacardio.2020.7434
DO - 10.1001/jamacardio.2020.7434
M3 - Article
SN - 2380-6583
VL - 6
SP - 539
EP - 548
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 5
ER -