Autograft reoperations after the Ross procedure
Aortic valve replacement with a pulmonary autograft offers patients a living valve substitute that provides excellent haemodynamics, freedom from long-term use of anticoagulation, minimal valve-related complications and the ability to grow. Abstract OBJECTIVES After a Ross procedure, autograft failu...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2023-05, Vol.63 (5) |
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| creator | Abeln, Karen B Ehrlich, Tristan Souko, Idriss Brenner, Friederike Schäfers, Hans-Joachim |
| description | Aortic valve replacement with a pulmonary autograft offers patients a living valve substitute that provides excellent haemodynamics, freedom from long-term use of anticoagulation, minimal valve-related complications and the ability to grow.
Abstract
OBJECTIVES
After a Ross procedure, autograft failure can occur. At reoperation, repair of the autograft preserves the advantages of the Ross procedure. The aim of this retrospective study was to assess mid-term results after reoperation of a failed autograft.
METHODS
Between 1997 and 2022, 30 consecutive patients (83% male; age 41 ± 11 years) underwent autograft reintervention between 60 days and 24 years (median 10 years) after a Ross procedure. The initial technique varied, full-root replacement (n = 25) being the most frequent. The indication for reoperation was isolated autograft regurgitation (n = 7), root dilatation (>43 mm) with (n = 17) or without (n = 2) autograft regurgitation, mixed dysfunction (n = 2) and endocarditis (n = 2). In 4 instances, the valve was replaced by valve (n = 1) or combined valve and root replacement (n = 3). Valve-sparing procedures consisted of isolated valve repair (n = 7) or root replacement (n = 19), and tubular aortic replacement. Cusp repair was performed in all but 2. Mean follow-up was 5.4 ± 6 years (35 days to 24 years).
RESULTS
Mean cross-clamp and perfusion times were 74 ± 26 and 132 ± 64 min. There were 2 perioperative deaths (7%; both valve replacement) and 2 patients died late (32 days to 1.2 years postoperatively). Freedom from cardiac death at 10 years was 96% after valve repair and 50% after replacement. Two patients required reoperation (1.68 and 16 years) following repair. One underwent valve replacement for cusp perforation, the other, root remodelling for dilatation. Freedom from autograft reintervention at 15 years was 95%.
CONCLUSIONS
Autograft reoperations after the Ross procedure can be performed as valve-sparing operations in the majority of cases. With valve-sparing, long-term survival and freedom from reoperation are excellent. |
| doi_str_mv | 10.1093/ejcts/ezad117 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10162808</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ejcts/ezad117</oup_id><sourcerecordid>2791704993</sourcerecordid><originalsourceid>FETCH-LOGICAL-c421t-16f8227e5516fc12c7640b34c0de890d6531e16d1c16067bc89354e8f2894d3a3</originalsourceid><addsrcrecordid>eNqFUE1Lw0AUXESxWj16lRy9xO5Hsh8nKcUvKAii4G3Zbl7alDQbdzeC_nqjrbWePL3hvWFm3iB0RvAlwYqNYGljGMGHKQgRe-iISMFSwbKX_R08QMchLDHGnFFxiAaMK0E4pkdoNO6im3tTxsSDa8GbWLkmJP0CfBIXkDy6EJLWOwtF5-EEHZSmDnC6mUP0fHP9NLlLpw-395PxNLUZJTElvJSUCsjzHllCreAZnrHM4gKkwgXPGQHCC2L7GFzMrFQsz0CWVKqsYIYN0dVat-1mKygsNNGbWre-Whn_rp2p9N9LUy303L1pggmnEste4WKj4N1rByHqVRUs1LVpwHVBU6GIwJlSrKema6r1_bMeyq0PwfqrZf3dst603PPPd8Nt2T-1_nq7rv1H6xPiYIhY</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2791704993</pqid></control><display><type>article</type><title>Autograft reoperations after the Ross procedure</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Abeln, Karen B ; Ehrlich, Tristan ; Souko, Idriss ; Brenner, Friederike ; Schäfers, Hans-Joachim</creator><creatorcontrib>Abeln, Karen B ; Ehrlich, Tristan ; Souko, Idriss ; Brenner, Friederike ; Schäfers, Hans-Joachim</creatorcontrib><description>Aortic valve replacement with a pulmonary autograft offers patients a living valve substitute that provides excellent haemodynamics, freedom from long-term use of anticoagulation, minimal valve-related complications and the ability to grow.
Abstract
OBJECTIVES
After a Ross procedure, autograft failure can occur. At reoperation, repair of the autograft preserves the advantages of the Ross procedure. The aim of this retrospective study was to assess mid-term results after reoperation of a failed autograft.
METHODS
Between 1997 and 2022, 30 consecutive patients (83% male; age 41 ± 11 years) underwent autograft reintervention between 60 days and 24 years (median 10 years) after a Ross procedure. The initial technique varied, full-root replacement (n = 25) being the most frequent. The indication for reoperation was isolated autograft regurgitation (n = 7), root dilatation (>43 mm) with (n = 17) or without (n = 2) autograft regurgitation, mixed dysfunction (n = 2) and endocarditis (n = 2). In 4 instances, the valve was replaced by valve (n = 1) or combined valve and root replacement (n = 3). Valve-sparing procedures consisted of isolated valve repair (n = 7) or root replacement (n = 19), and tubular aortic replacement. Cusp repair was performed in all but 2. Mean follow-up was 5.4 ± 6 years (35 days to 24 years).
RESULTS
Mean cross-clamp and perfusion times were 74 ± 26 and 132 ± 64 min. There were 2 perioperative deaths (7%; both valve replacement) and 2 patients died late (32 days to 1.2 years postoperatively). Freedom from cardiac death at 10 years was 96% after valve repair and 50% after replacement. Two patients required reoperation (1.68 and 16 years) following repair. One underwent valve replacement for cusp perforation, the other, root remodelling for dilatation. Freedom from autograft reintervention at 15 years was 95%.
CONCLUSIONS
Autograft reoperations after the Ross procedure can be performed as valve-sparing operations in the majority of cases. With valve-sparing, long-term survival and freedom from reoperation are excellent.</description><identifier>ISSN: 1873-734X</identifier><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezad117</identifier><identifier>PMID: 36971602</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Aortic Valve - surgery ; Aortic Valve Insufficiency - surgery ; Autografts ; Conventional Valve Operations ; Dilatation, Pathologic - surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Pulmonary Valve - transplantation ; Reoperation - methods ; Retrospective Studies ; Transplantation, Autologous ; Treatment Outcome</subject><ispartof>European journal of cardio-thoracic surgery, 2023-05, Vol.63 (5)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c421t-16f8227e5516fc12c7640b34c0de890d6531e16d1c16067bc89354e8f2894d3a3</citedby><cites>FETCH-LOGICAL-c421t-16f8227e5516fc12c7640b34c0de890d6531e16d1c16067bc89354e8f2894d3a3</cites><orcidid>0000-0002-0251-9100 ; 0000-0001-6110-3124 ; 0000-0001-6217-5963</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36971602$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abeln, Karen B</creatorcontrib><creatorcontrib>Ehrlich, Tristan</creatorcontrib><creatorcontrib>Souko, Idriss</creatorcontrib><creatorcontrib>Brenner, Friederike</creatorcontrib><creatorcontrib>Schäfers, Hans-Joachim</creatorcontrib><title>Autograft reoperations after the Ross procedure</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Aortic valve replacement with a pulmonary autograft offers patients a living valve substitute that provides excellent haemodynamics, freedom from long-term use of anticoagulation, minimal valve-related complications and the ability to grow.
Abstract
OBJECTIVES
After a Ross procedure, autograft failure can occur. At reoperation, repair of the autograft preserves the advantages of the Ross procedure. The aim of this retrospective study was to assess mid-term results after reoperation of a failed autograft.
METHODS
Between 1997 and 2022, 30 consecutive patients (83% male; age 41 ± 11 years) underwent autograft reintervention between 60 days and 24 years (median 10 years) after a Ross procedure. The initial technique varied, full-root replacement (n = 25) being the most frequent. The indication for reoperation was isolated autograft regurgitation (n = 7), root dilatation (>43 mm) with (n = 17) or without (n = 2) autograft regurgitation, mixed dysfunction (n = 2) and endocarditis (n = 2). In 4 instances, the valve was replaced by valve (n = 1) or combined valve and root replacement (n = 3). Valve-sparing procedures consisted of isolated valve repair (n = 7) or root replacement (n = 19), and tubular aortic replacement. Cusp repair was performed in all but 2. Mean follow-up was 5.4 ± 6 years (35 days to 24 years).
RESULTS
Mean cross-clamp and perfusion times were 74 ± 26 and 132 ± 64 min. There were 2 perioperative deaths (7%; both valve replacement) and 2 patients died late (32 days to 1.2 years postoperatively). Freedom from cardiac death at 10 years was 96% after valve repair and 50% after replacement. Two patients required reoperation (1.68 and 16 years) following repair. One underwent valve replacement for cusp perforation, the other, root remodelling for dilatation. Freedom from autograft reintervention at 15 years was 95%.
CONCLUSIONS
Autograft reoperations after the Ross procedure can be performed as valve-sparing operations in the majority of cases. With valve-sparing, long-term survival and freedom from reoperation are excellent.</description><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Insufficiency - surgery</subject><subject>Autografts</subject><subject>Conventional Valve Operations</subject><subject>Dilatation, Pathologic - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Pulmonary Valve - transplantation</subject><subject>Reoperation - methods</subject><subject>Retrospective Studies</subject><subject>Transplantation, Autologous</subject><subject>Treatment Outcome</subject><issn>1873-734X</issn><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqFUE1Lw0AUXESxWj16lRy9xO5Hsh8nKcUvKAii4G3Zbl7alDQbdzeC_nqjrbWePL3hvWFm3iB0RvAlwYqNYGljGMGHKQgRe-iISMFSwbKX_R08QMchLDHGnFFxiAaMK0E4pkdoNO6im3tTxsSDa8GbWLkmJP0CfBIXkDy6EJLWOwtF5-EEHZSmDnC6mUP0fHP9NLlLpw-395PxNLUZJTElvJSUCsjzHllCreAZnrHM4gKkwgXPGQHCC2L7GFzMrFQsz0CWVKqsYIYN0dVat-1mKygsNNGbWre-Whn_rp2p9N9LUy303L1pggmnEste4WKj4N1rByHqVRUs1LVpwHVBU6GIwJlSrKema6r1_bMeyq0PwfqrZf3dst603PPPd8Nt2T-1_nq7rv1H6xPiYIhY</recordid><startdate>20230502</startdate><enddate>20230502</enddate><creator>Abeln, Karen B</creator><creator>Ehrlich, Tristan</creator><creator>Souko, Idriss</creator><creator>Brenner, Friederike</creator><creator>Schäfers, Hans-Joachim</creator><general>Oxford University Press</general><scope>TOX</scope><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><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0251-9100</orcidid><orcidid>https://orcid.org/0000-0001-6110-3124</orcidid><orcidid>https://orcid.org/0000-0001-6217-5963</orcidid></search><sort><creationdate>20230502</creationdate><title>Autograft reoperations after the Ross procedure</title><author>Abeln, Karen B ; Ehrlich, Tristan ; Souko, Idriss ; Brenner, Friederike ; Schäfers, Hans-Joachim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c421t-16f8227e5516fc12c7640b34c0de890d6531e16d1c16067bc89354e8f2894d3a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Insufficiency - surgery</topic><topic>Autografts</topic><topic>Conventional Valve Operations</topic><topic>Dilatation, Pathologic - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Pulmonary Valve - transplantation</topic><topic>Reoperation - methods</topic><topic>Retrospective Studies</topic><topic>Transplantation, Autologous</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abeln, Karen B</creatorcontrib><creatorcontrib>Ehrlich, Tristan</creatorcontrib><creatorcontrib>Souko, Idriss</creatorcontrib><creatorcontrib>Brenner, Friederike</creatorcontrib><creatorcontrib>Schäfers, Hans-Joachim</creatorcontrib><collection>Oxford Journals Open Access Collection</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abeln, Karen B</au><au>Ehrlich, Tristan</au><au>Souko, Idriss</au><au>Brenner, Friederike</au><au>Schäfers, Hans-Joachim</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Autograft reoperations after the Ross procedure</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2023-05-02</date><risdate>2023</risdate><volume>63</volume><issue>5</issue><issn>1873-734X</issn><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Aortic valve replacement with a pulmonary autograft offers patients a living valve substitute that provides excellent haemodynamics, freedom from long-term use of anticoagulation, minimal valve-related complications and the ability to grow.
Abstract
OBJECTIVES
After a Ross procedure, autograft failure can occur. At reoperation, repair of the autograft preserves the advantages of the Ross procedure. The aim of this retrospective study was to assess mid-term results after reoperation of a failed autograft.
METHODS
Between 1997 and 2022, 30 consecutive patients (83% male; age 41 ± 11 years) underwent autograft reintervention between 60 days and 24 years (median 10 years) after a Ross procedure. The initial technique varied, full-root replacement (n = 25) being the most frequent. The indication for reoperation was isolated autograft regurgitation (n = 7), root dilatation (>43 mm) with (n = 17) or without (n = 2) autograft regurgitation, mixed dysfunction (n = 2) and endocarditis (n = 2). In 4 instances, the valve was replaced by valve (n = 1) or combined valve and root replacement (n = 3). Valve-sparing procedures consisted of isolated valve repair (n = 7) or root replacement (n = 19), and tubular aortic replacement. Cusp repair was performed in all but 2. Mean follow-up was 5.4 ± 6 years (35 days to 24 years).
RESULTS
Mean cross-clamp and perfusion times were 74 ± 26 and 132 ± 64 min. There were 2 perioperative deaths (7%; both valve replacement) and 2 patients died late (32 days to 1.2 years postoperatively). Freedom from cardiac death at 10 years was 96% after valve repair and 50% after replacement. Two patients required reoperation (1.68 and 16 years) following repair. One underwent valve replacement for cusp perforation, the other, root remodelling for dilatation. Freedom from autograft reintervention at 15 years was 95%.
CONCLUSIONS
Autograft reoperations after the Ross procedure can be performed as valve-sparing operations in the majority of cases. With valve-sparing, long-term survival and freedom from reoperation are excellent.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>36971602</pmid><doi>10.1093/ejcts/ezad117</doi><orcidid>https://orcid.org/0000-0002-0251-9100</orcidid><orcidid>https://orcid.org/0000-0001-6110-3124</orcidid><orcidid>https://orcid.org/0000-0001-6217-5963</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of cardio-thoracic surgery, 2023-05, Vol.63 (5) |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aortic Valve - surgery Aortic Valve Insufficiency - surgery Autografts Conventional Valve Operations Dilatation, Pathologic - surgery Female Follow-Up Studies Humans Infant Male Pulmonary Valve - transplantation Reoperation - methods Retrospective Studies Transplantation, Autologous Treatment Outcome |
| title | Autograft reoperations after the Ross procedure |
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