Outcomes of redo operations after the Ross procedure
The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center. We retrospectively reviewed 225 consecutive patients who under...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2023-05, Vol.165 (5), p.1803-1812.e2 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Shih, Emily Brinkman, William T. Harrington, Katherine B. Squiers, John J. Rahimighazikalayeh, Gelareh DiMaio, J. Michael Ryan, William H. |
| description | The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center.
We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo operations. Multivariate analysis was used to identify independent predictors of Ross-related reinterventions. Survival was estimated with Kaplan–Meier analysis.
Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reintervention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to reintervention was 11 ± 6 years for autograft reoperations and 12 ± 7 years for homograft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 ± 11 years vs 43 ± 11 years; P |
| doi_str_mv | 10.1016/j.jtcvs.2022.04.023 |
| format | Article |
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We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo operations. Multivariate analysis was used to identify independent predictors of Ross-related reinterventions. Survival was estimated with Kaplan–Meier analysis.
Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reintervention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to reintervention was 11 ± 6 years for autograft reoperations and 12 ± 7 years for homograft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 ± 11 years vs 43 ± 11 years; P < .01) and had a higher rate of New York Heart Association class III/IV (56% vs 38%; P = .02) at the index Ross procedure. Most patients undergoing autograft reintervention had aortic insufficiency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft reintervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years was similar in patients who required a redo operation and those who did not (91.2% vs 93.9%; P = .23).
Ross reinterventions can be performed safely and maintain patients at the normal life expectancy restored by the index Ross procedure up to 15 years at experienced centers.
[Display omitted]</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2022.04.023</identifier><identifier>PMID: 36028359</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aortic Valve - diagnostic imaging ; Aortic Valve - surgery ; Aortic Valve Insufficiency - diagnostic imaging ; Aortic Valve Insufficiency - etiology ; Aortic Valve Insufficiency - surgery ; aortic valve replacement ; Aortic Valve Stenosis - surgery ; Follow-Up Studies ; Heart Valve Prosthesis Implantation - methods ; Humans ; Pulmonary Valve - surgery ; Pulmonary Valve - transplantation ; Pulmonary Valve Stenosis - surgery ; reintervention after Ross ; Reoperation ; Retrospective Studies ; Ross ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2023-05, Vol.165 (5), p.1803-1812.e2</ispartof><rights>2022 The American Association for Thoracic Surgery</rights><rights>Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-f5516a9593da64306a4177fc1ad8146b394f79100d0654084591925156e7b0ff3</citedby><cites>FETCH-LOGICAL-c359t-f5516a9593da64306a4177fc1ad8146b394f79100d0654084591925156e7b0ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2022.04.023$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3541,27915,27916,45986</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36028359$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shih, Emily</creatorcontrib><creatorcontrib>Brinkman, William T.</creatorcontrib><creatorcontrib>Harrington, Katherine B.</creatorcontrib><creatorcontrib>Squiers, John J.</creatorcontrib><creatorcontrib>Rahimighazikalayeh, Gelareh</creatorcontrib><creatorcontrib>DiMaio, J. Michael</creatorcontrib><creatorcontrib>Ryan, William H.</creatorcontrib><title>Outcomes of redo operations after the Ross procedure</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center.
We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo operations. Multivariate analysis was used to identify independent predictors of Ross-related reinterventions. Survival was estimated with Kaplan–Meier analysis.
Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reintervention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to reintervention was 11 ± 6 years for autograft reoperations and 12 ± 7 years for homograft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 ± 11 years vs 43 ± 11 years; P < .01) and had a higher rate of New York Heart Association class III/IV (56% vs 38%; P = .02) at the index Ross procedure. Most patients undergoing autograft reintervention had aortic insufficiency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft reintervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years was similar in patients who required a redo operation and those who did not (91.2% vs 93.9%; P = .23).
Ross reinterventions can be performed safely and maintain patients at the normal life expectancy restored by the index Ross procedure up to 15 years at experienced centers.
[Display omitted]</description><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Insufficiency - diagnostic imaging</subject><subject>Aortic Valve Insufficiency - etiology</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>aortic valve replacement</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Follow-Up Studies</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Humans</subject><subject>Pulmonary Valve - surgery</subject><subject>Pulmonary Valve - transplantation</subject><subject>Pulmonary Valve Stenosis - surgery</subject><subject>reintervention after Ross</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Ross</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtLAzEQx4MotlY_gSB79LLr5LnNwYMUX1AoiIK3kGYnuKVtarJb8Nub2urR0xzm_5j5EXJJoaJA1c2iWnRumyoGjFUgKmD8iAwp6LpUY_l-TIaQN6VkjA_IWUoLAKiB6lMy4ArYmEs9JGLWdy6sMBXBFxGbUIQNRtu1YZ0K6zuMRfeBxUtIqdjE4LDpI56TE2-XCS8Oc0TeHu5fJ0_ldPb4PLmbli5nd6WXkiqrpeaNVYKDsoLWtXfUNmMq1Jxr4WtNARpQUsBYSE01k1QqrOfgPR-R631ubv7sMXVm1SaHy6VdY-iTYTXUUmsGOkv5XupiPjWiN5vYrmz8MhTMDpdZmB9cZofLgDAZV3ZdHQr6-QqbP88vnyy43Qswv7ltMZrkWlxnDG1E15kmtP8WfAP2sXp2</recordid><startdate>202305</startdate><enddate>202305</enddate><creator>Shih, Emily</creator><creator>Brinkman, William T.</creator><creator>Harrington, Katherine B.</creator><creator>Squiers, John J.</creator><creator>Rahimighazikalayeh, Gelareh</creator><creator>DiMaio, J. Michael</creator><creator>Ryan, William H.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202305</creationdate><title>Outcomes of redo operations after the Ross procedure</title><author>Shih, Emily ; Brinkman, William T. ; Harrington, Katherine B. ; Squiers, John J. ; Rahimighazikalayeh, Gelareh ; DiMaio, J. Michael ; Ryan, William H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-f5516a9593da64306a4177fc1ad8146b394f79100d0654084591925156e7b0ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Insufficiency - diagnostic imaging</topic><topic>Aortic Valve Insufficiency - etiology</topic><topic>Aortic Valve Insufficiency - surgery</topic><topic>aortic valve replacement</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Follow-Up Studies</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Humans</topic><topic>Pulmonary Valve - surgery</topic><topic>Pulmonary Valve - transplantation</topic><topic>Pulmonary Valve Stenosis - surgery</topic><topic>reintervention after Ross</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Ross</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shih, Emily</creatorcontrib><creatorcontrib>Brinkman, William T.</creatorcontrib><creatorcontrib>Harrington, Katherine B.</creatorcontrib><creatorcontrib>Squiers, John J.</creatorcontrib><creatorcontrib>Rahimighazikalayeh, Gelareh</creatorcontrib><creatorcontrib>DiMaio, J. Michael</creatorcontrib><creatorcontrib>Ryan, William H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shih, Emily</au><au>Brinkman, William T.</au><au>Harrington, Katherine B.</au><au>Squiers, John J.</au><au>Rahimighazikalayeh, Gelareh</au><au>DiMaio, J. Michael</au><au>Ryan, William H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of redo operations after the Ross procedure</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2023-05</date><risdate>2023</risdate><volume>165</volume><issue>5</issue><spage>1803</spage><epage>1812.e2</epage><pages>1803-1812.e2</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center.
We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo operations. Multivariate analysis was used to identify independent predictors of Ross-related reinterventions. Survival was estimated with Kaplan–Meier analysis.
Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reintervention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to reintervention was 11 ± 6 years for autograft reoperations and 12 ± 7 years for homograft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 ± 11 years vs 43 ± 11 years; P < .01) and had a higher rate of New York Heart Association class III/IV (56% vs 38%; P = .02) at the index Ross procedure. Most patients undergoing autograft reintervention had aortic insufficiency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft reintervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years was similar in patients who required a redo operation and those who did not (91.2% vs 93.9%; P = .23).
Ross reinterventions can be performed safely and maintain patients at the normal life expectancy restored by the index Ross procedure up to 15 years at experienced centers.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36028359</pmid><doi>10.1016/j.jtcvs.2022.04.023</doi></addata></record> |
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| ispartof | The Journal of thoracic and cardiovascular surgery, 2023-05, Vol.165 (5), p.1803-1812.e2 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Aortic Valve - diagnostic imaging Aortic Valve - surgery Aortic Valve Insufficiency - diagnostic imaging Aortic Valve Insufficiency - etiology Aortic Valve Insufficiency - surgery aortic valve replacement Aortic Valve Stenosis - surgery Follow-Up Studies Heart Valve Prosthesis Implantation - methods Humans Pulmonary Valve - surgery Pulmonary Valve - transplantation Pulmonary Valve Stenosis - surgery reintervention after Ross Reoperation Retrospective Studies Ross Treatment Outcome |
| title | Outcomes of redo operations after the Ross procedure |
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