Long-Term Outcomes of Patients Undergoing the Ross Procedure.
J Am Coll Cardiol
; 77(11): 1412-1422, 2021 03 23.
Article
de En
| MEDLINE
| ID: mdl-33736823
ABSTRACT
BACKGROUND:
Treatment of aortic-valve disease in young patients still poses challenges. The Ross procedure offers several potential advantages that may translate to improved long-term outcomes.OBJECTIVES:
This study reports long-term outcomes after the Ross procedure.METHODS:
Adult patients who were included in the Ross Registry between 1988 and 2018 were analyzed. Endpoints were overall survival, reintervention, and major adverse events at maximum follow-up. Multivariable regression analyses were performed to identify risk factors for survival and the need of Ross-related reintervention.RESULTS:
There were 2,444 adult patients with a mean age of 44.1 ± 11.7 years identified. Early mortality was 1.0%. Estimated survival after 25 years was 75.8% and did not statistically differ from the general population (p = 0.189). The risk for autograft reintervention was 0.69% per patient-year and 0.62% per patient-year for right-ventricular outflow tract (RVOT) reintervention. Larger aortic annulus diameter (hazard ratio [HR] 1.12/mm; 95% confidence interval [CI] 1.05 to 1.19/mm; p < 0.001) and pre-operative presence of pure aortic insufficiency (HR 1.74; 95% CI 1.13 to 2.68; p = 0.01) were independent predictors for autograft reintervention, whereas the use of a biological valve (HR 8.09; 95% CI 5.01 to 13.08; p < 0.001) and patient age (HR 0.97 per year; 95% CI 0.96 to 0.99; p = 0.001) were independent predictors for RVOT reintervention. Major bleeding, valve thrombosis, permanent stroke, and endocarditis occurred with an incidence of 0.15% per patient-year, 0.07% per patient-year, 0.13%, and 0.36% per patient-year, respectively.CONCLUSIONS:
The Ross procedure provides excellent survival over a follow-up period of up to 25 years. The rates of reintervention, anticoagulation-related morbidity, and endocarditis were very low. This procedure should therefore be considered as a very suitable treatment option in young patients suffering from aortic-valve disease. (Long-Term Follow-up After the Autograft Aortic Valve Procedure [Ross Operation]; NCT00708409).Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Valve aortique
/
Complications postopératoires
/
Réintervention
/
Transplantation autologue
/
Implantation de valve prothétique cardiaque
/
Effets indésirables à long terme
/
Maladie de la valve aortique
Type d'étude:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Pays/Région comme sujet:
Europa
Langue:
En
Journal:
J Am Coll Cardiol
Année:
2021
Type de document:
Article