Autograft regurgitation and aortic root dimensions after the ross procedure : The german ross registry experience
Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation. Between...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2007-09, Vol.116 (11), p.I251-I258 |
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| creator | HANKE, Thorsten STIERLE, Ulrich LANGE, Rüdiger HÖRER, Jürgen MORITZ, Anton OZASLAN, Feyzan WAHLERS, Thorsten FRANKE, Ulrich F. W HETZER, Roland HÜBLER, Michael ZIEMER, Gerhard GRAF, Bernhard BOEHM, Juergen O ROSS, Donald N SIEVERS, Hans H BOTHA, Cornelius A MATTHIAS BECHTEL, J. F ERASMI, Armin MISFELD, Martin HEMMER, Wolfgang REIN, Joachim G ROBINSON, Derek R |
| description | Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation.
Between 1990 and 2006 1014 patients (786 men, 228 women; mean age 41.2+/-15.3 years) underwent the Ross procedure using 2 different implantation techniques (subcoronary, n=521; root replacement, n=493). Clinical and serial echocardiographic follow up was performed preoperatively and thereafter annually (mean follow up 4.41+/-3.11 years, median 3.93 years, range 0 to 16.04 years; 5012 patient-years). For statistical analysis of serial echocardiograms, a hierarchical multilevel modeling technique was applied. Eight early and 28 late deaths were observed. Pulmonary autograft reoperations were required in 35 patients. Initial autograft regurgitation grade was 0.49 (root replacement 0.73, subcoronary 0.38) with an annual increase of grade 0.034 (root replacement 0.0259, subcoronary 0.0231). Annulus and sinus dimensions did not exhibit an essential increase over time in both techniques, whereas sinotubular junction diameter increased essentially by 0.5 mm per year in patients with root replacement. Patients with the subcoronary implantation technique showed nearly unchanged dimensions. Bicuspid aortic valve morphology did not have any consistent impact on root dimensions with time irrespective of the performed surgical technique.
The present Ross series from the German Ross Registry showed favorable clinical and hemodynamic results. Development of autograft regurgitation for both techniques was small and the annual progression thereof is currently not substantial. Use of the subcoronary technique and aortic root interventions with stabilizing measures in root replacement patients seem to prevent autograft regurgitation and dilatation of the aortic root within the timeframe studied. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.106.678797 |
| format | Article |
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Between 1990 and 2006 1014 patients (786 men, 228 women; mean age 41.2+/-15.3 years) underwent the Ross procedure using 2 different implantation techniques (subcoronary, n=521; root replacement, n=493). Clinical and serial echocardiographic follow up was performed preoperatively and thereafter annually (mean follow up 4.41+/-3.11 years, median 3.93 years, range 0 to 16.04 years; 5012 patient-years). For statistical analysis of serial echocardiograms, a hierarchical multilevel modeling technique was applied. Eight early and 28 late deaths were observed. Pulmonary autograft reoperations were required in 35 patients. Initial autograft regurgitation grade was 0.49 (root replacement 0.73, subcoronary 0.38) with an annual increase of grade 0.034 (root replacement 0.0259, subcoronary 0.0231). Annulus and sinus dimensions did not exhibit an essential increase over time in both techniques, whereas sinotubular junction diameter increased essentially by 0.5 mm per year in patients with root replacement. Patients with the subcoronary implantation technique showed nearly unchanged dimensions. Bicuspid aortic valve morphology did not have any consistent impact on root dimensions with time irrespective of the performed surgical technique.
The present Ross series from the German Ross Registry showed favorable clinical and hemodynamic results. Development of autograft regurgitation for both techniques was small and the annual progression thereof is currently not substantial. Use of the subcoronary technique and aortic root interventions with stabilizing measures in root replacement patients seem to prevent autograft regurgitation and dilatation of the aortic root within the timeframe studied.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.106.678797</identifier><identifier>PMID: 17846313</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aortic Valve - transplantation ; Aortic Valve Insufficiency - epidemiology ; Aortic Valve Insufficiency - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cardiovascular system ; Diseases of the aorta ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Germany - epidemiology ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Registries ; Transplantation, Autologous</subject><ispartof>Circulation (New York, N.Y.), 2007-09, Vol.116 (11), p.I251-I258</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c339t-a0a96a5050a34c756dc3dc852b645d6f0a17f3f2b6f05a1843b258ebdb3d51463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,3674,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19074817$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17846313$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HANKE, Thorsten</creatorcontrib><creatorcontrib>STIERLE, Ulrich</creatorcontrib><creatorcontrib>LANGE, Rüdiger</creatorcontrib><creatorcontrib>HÖRER, Jürgen</creatorcontrib><creatorcontrib>MORITZ, Anton</creatorcontrib><creatorcontrib>OZASLAN, Feyzan</creatorcontrib><creatorcontrib>WAHLERS, Thorsten</creatorcontrib><creatorcontrib>FRANKE, Ulrich F. W</creatorcontrib><creatorcontrib>HETZER, Roland</creatorcontrib><creatorcontrib>HÜBLER, Michael</creatorcontrib><creatorcontrib>ZIEMER, Gerhard</creatorcontrib><creatorcontrib>GRAF, Bernhard</creatorcontrib><creatorcontrib>BOEHM, Juergen O</creatorcontrib><creatorcontrib>ROSS, Donald N</creatorcontrib><creatorcontrib>SIEVERS, Hans H</creatorcontrib><creatorcontrib>BOTHA, Cornelius A</creatorcontrib><creatorcontrib>MATTHIAS BECHTEL, J. F</creatorcontrib><creatorcontrib>ERASMI, Armin</creatorcontrib><creatorcontrib>MISFELD, Martin</creatorcontrib><creatorcontrib>HEMMER, Wolfgang</creatorcontrib><creatorcontrib>REIN, Joachim G</creatorcontrib><creatorcontrib>ROBINSON, Derek R</creatorcontrib><creatorcontrib>German Ross Registry</creatorcontrib><title>Autograft regurgitation and aortic root dimensions after the ross procedure : The german ross registry experience</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Autograft regurgitation and root dilatation after the Ross procedure is of major concern. We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation.
Between 1990 and 2006 1014 patients (786 men, 228 women; mean age 41.2+/-15.3 years) underwent the Ross procedure using 2 different implantation techniques (subcoronary, n=521; root replacement, n=493). Clinical and serial echocardiographic follow up was performed preoperatively and thereafter annually (mean follow up 4.41+/-3.11 years, median 3.93 years, range 0 to 16.04 years; 5012 patient-years). For statistical analysis of serial echocardiograms, a hierarchical multilevel modeling technique was applied. Eight early and 28 late deaths were observed. Pulmonary autograft reoperations were required in 35 patients. Initial autograft regurgitation grade was 0.49 (root replacement 0.73, subcoronary 0.38) with an annual increase of grade 0.034 (root replacement 0.0259, subcoronary 0.0231). Annulus and sinus dimensions did not exhibit an essential increase over time in both techniques, whereas sinotubular junction diameter increased essentially by 0.5 mm per year in patients with root replacement. Patients with the subcoronary implantation technique showed nearly unchanged dimensions. Bicuspid aortic valve morphology did not have any consistent impact on root dimensions with time irrespective of the performed surgical technique.
The present Ross series from the German Ross Registry showed favorable clinical and hemodynamic results. Development of autograft regurgitation for both techniques was small and the annual progression thereof is currently not substantial. Use of the subcoronary technique and aortic root interventions with stabilizing measures in root replacement patients seem to prevent autograft regurgitation and dilatation of the aortic root within the timeframe studied.</description><subject>Adult</subject><subject>Aortic Valve - transplantation</subject><subject>Aortic Valve Insufficiency - epidemiology</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Diseases of the aorta</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Germany - epidemiology</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Registries</subject><subject>Transplantation, Autologous</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkF1r2zAUhkVZWdN2f6FoF-udM8myJHt3xnRLIKxQ0mtzLB1nGrGdSjI0_74qCZReHc55n_P1EvKdsyXniv9s1k_N86berh__1qt6yZlaKl3qSl-QBZd5kRVSVF_IgjFWZVrk-RW5DuF_SpXQ8iu54roslOBiQV7qOU47D32kHnez37kI0U0jhdFSmHx0hvppitS6AceQlEATjJ7Gf5iUEOjBTwbt7JH-ottU3KEfYDxpaaYL0R8pvh7QOxwN3pLLHvYBv53jDXn-_bBtVtnm8c-6qTeZEaKKGTCoFEgmGYjCaKmsEdaUMu9UIa3qGXDdiz6lPZPAy0J0uSyxs52wkqfvbsj9aW6672XGENvBBYP7PYw4zaFVZZ5cyvMEVifQvJ_ssW8P3g3gjy1n7bvf7We_U1m1J79T7915ydwNaD86zwYn4McZgGBg33sYjQsfXMV0UXIt3gAwroyy</recordid><startdate>20070911</startdate><enddate>20070911</enddate><creator>HANKE, Thorsten</creator><creator>STIERLE, Ulrich</creator><creator>LANGE, Rüdiger</creator><creator>HÖRER, Jürgen</creator><creator>MORITZ, Anton</creator><creator>OZASLAN, Feyzan</creator><creator>WAHLERS, Thorsten</creator><creator>FRANKE, Ulrich F. 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F</creatorcontrib><creatorcontrib>ERASMI, Armin</creatorcontrib><creatorcontrib>MISFELD, Martin</creatorcontrib><creatorcontrib>HEMMER, Wolfgang</creatorcontrib><creatorcontrib>REIN, Joachim G</creatorcontrib><creatorcontrib>ROBINSON, Derek R</creatorcontrib><creatorcontrib>German Ross Registry</creatorcontrib><collection>Pascal-Francis</collection><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>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HANKE, Thorsten</au><au>STIERLE, Ulrich</au><au>LANGE, Rüdiger</au><au>HÖRER, Jürgen</au><au>MORITZ, Anton</au><au>OZASLAN, Feyzan</au><au>WAHLERS, Thorsten</au><au>FRANKE, Ulrich F. 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We reviewed data from the German Ross Registry to document the development of autograft regurgitation and root dilatation with time and also to compare 2 different techniques of autograft implantation.
Between 1990 and 2006 1014 patients (786 men, 228 women; mean age 41.2+/-15.3 years) underwent the Ross procedure using 2 different implantation techniques (subcoronary, n=521; root replacement, n=493). Clinical and serial echocardiographic follow up was performed preoperatively and thereafter annually (mean follow up 4.41+/-3.11 years, median 3.93 years, range 0 to 16.04 years; 5012 patient-years). For statistical analysis of serial echocardiograms, a hierarchical multilevel modeling technique was applied. Eight early and 28 late deaths were observed. Pulmonary autograft reoperations were required in 35 patients. Initial autograft regurgitation grade was 0.49 (root replacement 0.73, subcoronary 0.38) with an annual increase of grade 0.034 (root replacement 0.0259, subcoronary 0.0231). Annulus and sinus dimensions did not exhibit an essential increase over time in both techniques, whereas sinotubular junction diameter increased essentially by 0.5 mm per year in patients with root replacement. Patients with the subcoronary implantation technique showed nearly unchanged dimensions. Bicuspid aortic valve morphology did not have any consistent impact on root dimensions with time irrespective of the performed surgical technique.
The present Ross series from the German Ross Registry showed favorable clinical and hemodynamic results. Development of autograft regurgitation for both techniques was small and the annual progression thereof is currently not substantial. Use of the subcoronary technique and aortic root interventions with stabilizing measures in root replacement patients seem to prevent autograft regurgitation and dilatation of the aortic root within the timeframe studied.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>17846313</pmid><doi>10.1161/CIRCULATIONAHA.106.678797</doi></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2007-09, Vol.116 (11), p.I251-I258 |
| issn | 0009-7322 1524-4539 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adult Aortic Valve - transplantation Aortic Valve Insufficiency - epidemiology Aortic Valve Insufficiency - surgery Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cardiovascular system Diseases of the aorta Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Germany - epidemiology Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Radiodiagnosis. Nmr imagery. Nmr spectrometry Registries Transplantation, Autologous |
| title | Autograft regurgitation and aortic root dimensions after the ross procedure : The german ross registry experience |
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