Ross Operation With Autologous External Autograft Stabilization—Long-term Results

Abeln, Karen B.; Schäfers, Sebastian; Ehrlich, Tristan; Federspiel, Jan M.; Schäfers, Hans‐Joachim

doi:10.1016/j.athoracsur.2021.09.017

Cited by 15 publications

(8 citation statements)

References 28 publications

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“…However, the mortality of post‐Ross reoperations in experienced hands, regardless of autograft or right ventricular outflow tract, is low, 34 , 35 and autograft valve‐sparing operations are frequently achievable. 34 Furthermore, the Ross operation has been modified to include specific technical elements: trimming of any excess muscle off the autograft; trimming of any excess autograft above the neosinotubular junction; placement of the autograft deep into the left ventricular outflow tract by meticulous attention to each suture (intra‐annular implantation for external annulus support); and providing external supports of the autograft annulus and the neosinotubular junction using various materials, particularly in patients with aortic insufficiency or large aortic annulus. 36 In addition to these technical aspects, the role of tight postoperative blood pressure regulation should not be understated.…”

Section: Discussionmentioning

confidence: 99%

“…These modifications with various meticulous refinements have become standard of care in current practice and are associated with reduction of late autograft dilatation and improved durability. 34 Although reintervention rates were higher with the Ross procedure compared with M‐AVR, the upper limit of CI was approaching 1; therefore, further follow‐up is necessary considering recent surgical and medical modifications. As for right‐side reinterventions after the Ross procedure, percutaneous therapies have emerged as the first‐line therapy for failed homografts or prostheses in the pulmonary position, 37 although the feasibility of these transcatheter approaches is not guaranteed, and the risk of procedure‐related complications, such as coronary compression, 38 and late complications, such as transcatheter pulmonary valve endocarditis, 39 exists.…”

Section: Discussionmentioning

confidence: 99%

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Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Yokoyama

Kuno

Toyoda

et al. 2023

JAHA

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Background The Ross operation appears to restore normal survival in young and middle‐aged adults with aortic valve disease. However, there are limited data comparing it with conventional aortic valve replacement. Herein, we compared outcomes of the Ross procedure with mechanical and bioprosthetic aortic valve replacement (M‐AVR and B‐AVR, respectively). Methods and Results MEDLINE and EMBASE were searched through March 2022 to identify randomized controlled trials and propensity score–matched studies that investigated outcomes of patients aged ≥16 years undergoing the Ross procedure, M‐AVR, or B‐AVR. The systematic literature search identified 2 randomized controlled trials and 8 propensity score–matched studies involving a total of 4812 patients (Ross: n=1991; M‐AVR: n=2019; and B‐AVR: n=802). All‐cause mortality was significantly lower in the Ross procedure group compared with M‐AVR (hazard ratio [HR] [95% CI], 0.58 [0.35–0.97]; P =0.035) and B‐AVR (HR [95% CI], 0.32 [0.18–0.59]; P <0.001) groups. The reintervention rate was lower after the Ross procedure and M‐AVR compared with B‐AVR, whereas it was higher after the Ross procedure compared with M‐AVR. Major bleeding rate was lower after the Ross procedure compared with M‐AVR. Long‐term stroke rate was lower following the Ross procedure compared with M‐AVR and B‐AVR. The rate of endocarditis was also lower after the Ross procedure compared with B‐AVR. Conclusions Improved long‐term outcomes of the Ross procedure are demonstrated compared with conventional M‐AVR and B‐AVR options. These results highlight a need to enhance the recognition of the Ross procedure and revisit current guidelines on the optimal valve substitute for young and middle‐aged patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Yokoyama

Kuno

Toyoda

et al. 2023

JAHA

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“…Truth is, however, that the use of external stabilization has proven to minimize the risk of failure caused by autograft dilatation with excellent long-term results. [ 69 - 71 ]…”

Section: Introductionmentioning

confidence: 99%

“…Truth is, however, that the use of external stabilization has proven to minimize the risk of failure caused by autograft dilatation with excellent long-term results. [69][70][71] This brief overview emphasizes that not all innovations have contributed to true progress in patient care, as defined by true advantages to the patients. Continued innovation are necessary, but it must be accompanied by critical reflection regarding its value to the patient.…”

mentioning

confidence: 99%

Recent innovations in aortic valve surgery: True progress?

Lausberg

Schäfers

2023

Turk Gogus Kalp Dama

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“…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 ]. Although midterm survival and durability were similar between different valve morphologies [ 17 ], a trend towards a higher increase in autograft size progression was shown for unicuspid valves [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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

Abeln

Matsushima

Ehrlich

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Background Aortic stenosis or regurgitation in patients with a unicuspid valve morphology require interventions early in life. We have performed either primary valve repair or the Ross procedure. The aim of this study was to compare the mid-term results of repair and pulmonary autograft replacement. Methods Between 12/1998 and 04/2022, 345 patients (77% male; mean age 34±9.7 years) underwent treatment of a unicuspid aortic valve. Patients were excluded if they were <18 years (n = 84) or > 54 years (n = 3) at the time of the operation. The remaining cohort was divided into 2 groups: 167 (64%) patients underwent valve repair, 91 (36%) patients underwent pulmonary autograft replacement. The indications for surgery were aortic regurgitation (n = 104), aortic stenosis (n = 45), combined disease (n = 103), and endocarditis (n = 6). Fifty-one patients had root dilatation (>43mm) with aortic regurgitation (repair n = 23; Ross n = 28). Mean follow-up was 5.9 (SD: 5 years) [range 0.1 to 22.3 years]. Results There was 1 early, 3 late deaths, and 47 patients required reintervention. Survival at 10 years was 95% in the Ross group and 97% after valve repair (p = 0.769). Freedom from reintervention at 10 years was 98% in the Ross group and 80% after valve repair (p = 0.012). A ROC curve analysis showed a trend towards better durability in patients < 26 years. Conclusion The ideal treatment of the unicuspid aortic valve remains debatable. Repair of a unicuspid valve can be considered a bridge to pulmonary autograft replacement, at least in younger patients. The appropriate time when to replace and when to repair requires further investigation.

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Ross Operation With Autologous External Autograft Stabilization—Long-term Results

Cited by 15 publications

References 28 publications

Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis

Recent innovations in aortic valve surgery: True progress?

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

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