Outcomes of redo operations after the Ross procedure

Shih, Emily; Brinkman, William T.; Harrington, Katherine; Squiers, John J.; Rahimighazikalayeh, Gelareh; DiMaio, J. Michael; Ryan, W. H.

doi:10.1016/j.jtcvs.2022.04.023

Cited by 10 publications

(3 citation statements)

References 21 publications

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“…In a recently published series, it was demonstrated that in expert centers, reoperations post-Ross procedure can be performed with low morbidity and mortality, ranging from 0% to 3% ( 10 – 12 ). In the study by Shih E. et al, there was no difference in 15-year survival between patients who underwent redo surgery (58 autograft reinterventions) and those patients who did not require reoperation after the Ross procedure ( 13 ).…”

Section: Discussionmentioning

confidence: 95%

Redo aortic root surgery post-Ross procedure

Bogachev-Prokophiev,

Sharifulin,

Demin

et al. 2023

Front. Cardiovasc. Med.

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BackgroundDespite numerous advantages of the Ross procedure, it presents a risk of late autograft and right ventricular outflow tract conduit failure. This study aimed to analyze the outcomes of autograft dysfunction reoperations using autograft-sparing and root replacement techniques.MethodsBetween 2015 and 2023, 49 patients underwent redo root surgery in our institution. Autograft valve-sparing procedures (VSP) were performed in 20 cases and the Bentall procedure (BP) in 29 patients. The short and long-term clinical outcomes along with echocardiographic results of VSP and BP were investigated.ResultsOverall early mortality rate was 2.0% with no significant difference between the groups. Severe autograft valve insufficiency at the time of redo (OR 4.07, P = 0.03) and patient age (OR 1.07, P = 0.04) were associated with a valve replacement procedure instead of VSP. The median follow-up duration was 34 months. No late deaths occurred in either group. Freedom from VSP failure and aortic prosthesis dysfunction were 93.8% and 94.1% in the VSP and BP groups, respectively. No reoperations were necessary in either group.ConclusionRedo aortic root surgery can be safely performed in patients with autograft failure. Both root replacement and autograft valve-sparing procedures demonstrated acceptable results at mid-term follow-up. Early redo surgery pre-empting severe aortic insufficiency increases the likelihood of preservation of the dilated autograft valve.

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Section: Discussionmentioning

confidence: 95%

Redo aortic root surgery post-Ross procedure

Bogachev-Prokophiev,

Sharifulin,

Demin

et al. 2023

Front. Cardiovasc. Med.

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“…This study, however, demonstrates that good long-term survival can be achieved despite neo-aortic root dilation or neo-aortic valve dysfunction after the index Ross operation, with 10-year survival of 92% and freedom-from-reoperation on the neo-aortic valve at 10-year of close to 80%, despite the required repair of the neo-aortic valve or neo-root replacement. In a recent study from Texas, Shih et al demonstrated the feasibility of reintervention after the Ross procedure with restoration of normal life expectancy, despite the necessary reintervention later on ( 8 , 9 ). The authors, however, performed more valve replacements than in our cohort of patients (40 out of 66 patients), where we generally aim at valve-preservation first.…”

Section: Discussionmentioning

confidence: 99%

Valve-sparing operations after Ross procedure: a single-center experience

Jahanyar¹,

Arabkhani²,

Zanella³

et al. 2023

Ann Cardiothorac Surg

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Background The Ross procedure has demonstrated excellent long-term results, with restoration of life-expectancy in patients with severe aortic valve dysfunction. However, reintervention after Ross can occur, and herein we describe our center’s experience with redo surgery after previous Ross procedures. Methods We searched our prospective database for aortic valve-repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacements (VSRRs) and/or aortic valve-repair after Ross procedure between July 2001 and July 2022. Univariable logistic regression analysis was performed to identify variables affecting early mortality. Survival, freedom-from-valve-reintervention and freedom-from-aortic regurgitation (AR) grade ≥3 were analyzed with the Kaplan-Meier method. Results A total of 63 patients were recruited for this study. Indication for reoperation after Ross was aortic aneurysm without AR in 17 (27%), aortic aneurysm with AR in 27 (43%), and isolated AR in 19 (30%) patients. Median follow-up time was 7.82 years. The majority of patients (76%) had undergone the free root technique during their index Ross operation. Cumulative survival, after redo surgery following Ross, was 98.4% [95% confidence interval (CI): 89.3–99.8%] at 1 year, 96.3% (95% CI: 88.2–98.3%) at 5 years, and 92.4% (95% CI: 87.1–98.0%) at 10 years. Freedom-from-reoperation on the aortic valve at 1 year was 98.4% (95% CI: 97.0–99.8%), at 5 years was 96.7% (95% CI: 87.6–99.0%), and 79.7% (95% CI: 71.1–88.3%) at 10 years. Conclusions Long-term survival after redo surgery following the Ross operation is excellent. The data support our aggressive valve-sparing approach after Ross.

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“…With great interest, we have read the report by Shih and colleagues, 4 who share their experience in adults, with a retrospective analysis of redo Ross operations from 1994 to 2019. Sixty-six of their 225 patients who underwent the Ross procedure required reoperations: 58 patients on either the autograft alone, or combined autograft with pulmonary homograft reoperations; and 8 patients on the homograft alone, with a mean time to reintervention of 11 and 12 years after the index operation, respectively.…”

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confidence: 99%