Complexity And Outcome Of Reoperations After The Ross Procedure In The Current Era
Elizabeth H. Stephens, Nibras El Sherif, Heidi M. Connolly, Gabor Bagameri, Alberto Pochettino, John M. Stulak, Joseph A. Dearani.
Mayo Clinic, Rochester, MN, USA.
Objectives The Ross procedure is an aortic valve replacement option with the potential for longer durability without anti-coagulation. However, the need for reintervention is inevitable and procedures may be complex. Our aim was to examine the complexity and outcomes of reoperation after the Ross procedure.
Methods Retrospective chart review of patients with prior Ross procedure who underwent their first reoperation at our institution from September 1991 to January 2021. Demographic, echocardiographic, surgical, and perioperative data were collected and analyzed. Results A total of 99 patients underwent reoperation after a Ross procedure performed either at our institution (n=16, 16.2%) or elsewhere (n=83, 83.8%). Mean age at Ross was 28 ±17years and mean age at first reoperation was 38.3 ±18.7 years. The most common Indication for surgery was severe combined autograft regurgitation/stenosis. A total of 235 procedures were performed. Autograft valve replacement or root replacement was performed in 74 patients (74.7%). Pulmonary valve or conduit replacement was performed in 47 patients (47.5%). Double root replacement was performed in 11 patients (11.1%). Aortic reconstruction was performed in 38 patients (38.4%). There were 4 early deaths (4%). The most common complication was arrhythmia in 20 (20.2%). Late deaths occurred in 9 patients (9%; total mortality 13.1%) during a median follow-up of 42 months (3-179 months). Patients with ejection fraction <30% on preoperative echo had shorter duration between Ross and subsequent reoperation (p=0.03).
Conclusion Reoperations after the Ross procedure are complex, associated with significant morbidity and mortality and should be advised prior to LV dysfunction.
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