Long-term Evaluation of the Ross Procedure in Acute Infective Endocarditis

Ratschiller, Thomas; Sames-Dolzer, Eva; Paulus, Patrick; Schimetta, Wolfgang; Müller, Hannes; Zierer, Andreas; Mair, Rudolf

doi:10.1053/j.semtcvs.2017.09.010

Cited by 25 publications

(22 citation statements)

References 29 publications

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“…These patients were under follow-up, one for 3 years and the other one for 5 years, and they did not have recurrent infective endocarditis. This finding is similar to the previous studies (20, 21). One of the three patients with infective endocarditis died.…”

Section: Discussionsupporting

confidence: 94%

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Ross operation early and mid-term results in children and young adults

Korun¹

2019

Anatol J Cardiol

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Objective: The Ross procedure has been cited as the procedure of choice for young patients requiring aortic valve replacement. However, potential for reintervention requirement in both left and right ventricular outflow tracts can be a source of concern. The aim of the present study was to describe our experience with this procedure. Methods: A retrospective chart review of all the patients who underwent the Ross procedure in a single institution was performed. National death registry records were used for late mortality. Results: Eighteen Ross procedures between May 2003 and May 2018 were performed. The median age of the cohort was 15 [interquartile range (IQR): 12-18] years. The pulmonic conduit was a homograft in 11 patients, Labcor in 5 patients, Contegra in 1 patient, and Medtronic Freestyle Valve in 1 patient. There were three early deaths. The median follow-up of 15 hospital survivors was 11 (IQR: 3–14) years. Any late mortality was not observed. In the two surviving patients with infective endocarditis, there was no recurrent infective endocarditis. Freedom from reintervention was 80% at 8 years and onward. Any risk factors associated with reintervention could not be identified. However, freedom from autograft dilatation at 10 years was 45%. Conclusion: Autograft failure is a potential problem in the long-term follow-up of Ross patients. Freedom from reintervention was satisfactory, and the type of pulmonic conduit did not affect the mid-term outcomes. In patients with infective endocarditis, the Ross procedure has a low recurrence rate, but it might have an increased risk of mortality.

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Section: Discussionsupporting

confidence: 94%

“…In our cohort, 3 out of 18 patients underwent the Ross procedure due to infective endocarditis. Low recurrence rates have been reported with the Ross procedure in adult patients with infective endocarditis (20, 21). However, data on pediatric patients with infective endocarditis are limited.…”

Section: Discussionmentioning

confidence: 98%

Ross operation early and mid-term results in children and young adults

Korun¹

2019

Anatol J Cardiol

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“…3,4,65,20,21 The use of aortic valve repair is limited and is preferable in native endocarditis caused by highly sensitive streptococci in which a small vegetation (<10 mm) is present on 1 leaflet of the aortic valve without the involvement of the annulus. 19 The goal of repairing the aortic valve is aimed at restoring an adequate area of coaptation of the leaflets in diastole with complete movement of the leaflets. The surgeon removes the vegetation (vegectomy) respecting the neckline on the leaflet and generally associating the use of a pericardial patch to reinforce the leaflet subjected to strong stress.…”

Section: %mentioning

confidence: 99%

“…In such cases, the Ross operation may be a suitable alternative to the use of homograft due to the increased risk of prosthetic-valve deterioration also for its biomechanical behavior made favorable by the fact of being in the presence of living tissue. 79 , 19 , 38 , 80 , 81 - 86 One randomized trial comparing autologous versus allogenic tissue in aortic valve surgery included 216 young adult patients (mean age 39 years), with follow-up duration exceeding a mean of 11 years, and reported a significantly better survival rate for patients undergoing Ross procedure than those whose AV replacement was managed with the use of a homograft (95% vs 78%; hazard ratio, 0.22; P = .006). 38 It highlighted the beneficial effect on long-term outcomes after the use of pulmonary artery (PA) in 43% of patients who had previous cardiac surgery.…”

Section: Clinical Evidencementioning

confidence: 99%

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Nappi

Singh

Timofeeva

2020

Clin Med Insights Cardiol

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Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.

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“…Homograft human aortic valves have also been used for replacement of the aortic root for decades, part of the Review Article rationale for its use is its superior resistance to infection (Figure 3) (41) . Another less explored option in IE has been the auto-transplantation of the pulmonary valve into the aortic position, the Ross operation (42,43) which some do recommend in IE. However, this type of operation, due to its complexity, is not common practice.…”

Section: The Aortic Valve and Rootmentioning

confidence: 99%

Surgical Aspects of Infective Endocarditis with Focus on the Aortic Root

Cuevas¹,

Savić²,

Quintana³

et al. 2018

ejcm

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Infective endocarditis is an uncommon disease carrying a mortality between 10% and 25%. The mitral and aortic valves are involved between 34-42% and 36-50% respectively. Early and aggressive treatment is mandatory, this impacts on early and long-term outcomes. A multi-disciplinary team approach is currently accepted as standard of practice. Approximately half of the patients require cardiac surgery as a part of the treatment. In case of extravalvular spread of infection, persistent sepsis, multiple embolic events despite appropriate antibiotic therapy, acute or worsening conduction abnormalities or heart failure, urgent surgery must be considered. When the infection involves the aortic root, a radical approach is preferred. As we expected, prosthetic valve endocarditis has worst outcomes, particularly related to the higher mortality in reoperations.

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Long-term Evaluation of the Ross Procedure in Acute Infective Endocarditis

Cited by 25 publications

References 29 publications

Ross operation early and mid-term results in children and young adults

Ross operation early and mid-term results in children and young adults

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Surgical Aspects of Infective Endocarditis with Focus on the Aortic Root

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