Ross operation after failure of aortic valve repair

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 minutes and 98 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 reintervention 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.

The Ross procedure versus repair for treatment of a unicuspid aortic valve in adults

“…Freedom from reoperation in our current study after the Ross procedure was 98% at 10 years. It was better than we had previously found in a mixed cohort of patients with UAVs (79% at 10 years) [ 18 ] and in patients with the Ross procedure as a reoperation [ 15 ]. This may be due to our current concept of external root stabilization; without external root stabilization, even more patients required reoperation (10 year freedom from reoperation was 63%) [ 18 ].…”

“…Repair is one alternative; the durability of unicuspid valve repair in a younger patient population has been suboptimal [ 2 , 12 , 13 ], and reoperations have been primarily related to patch degeneration [ 2 , 3 , 12 , 14 ]. The Ross procedure has become of interest in the last decade, in particular as a replacement option for valves that cannot be repaired [ 9 , 15 , 16 ]. Few studies have analysed the durability of the Ross procedure in unicuspid aortic valves [ 11 , 17 , 18 ].…”

Comparison of bicuspidization and Ross procedure in the treatment of unicuspid aortic valve disease in adults – Insight from the AVIATOR registry

“…Although this yet remains to be proven more robustly, this evidence may provide a rationale for a postponement of valve replacement. In a selected cohort of young adults with UAV, a staged approach utilizing bicuspidization followed by later valve replacement with pulmonary autograft might be beneficial, as proposed initially in the pediatric population by Schäfers et al ( 27 ).…”