What question did this study set out to answer?

To assess the mid-term outcomes of reoperations for autograft failure following the Ross procedure, comparing valve-sparing procedures with complete aortic root replacement.

December 12, 2023Frontiers in Cardiovascular MedicineOpen Access

Redo aortic root surgery post-Ross procedure

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Why the study?

Despite its advantages, the Ross procedure carries a risk of late autograft failure, prompting an analysis of reoperation outcomes using autograft-sparing versus root replacement techniques.

Does autograft valve-sparing procedure compared to Bentall procedure provide acceptable clinical outcomes in patients undergoing redo aortic root surgery post-Ross procedure?

Key Points

To assess the mid-term outcomes of reoperations for autograft failure following the Ross procedure, comparing valve-sparing procedures with complete aortic root replacement.
Single-center retrospective review of 49 patients undergoing redo aortic root surgery between 2015 and 2023.
Patients underwent either an autograft valve-sparing procedure (n=20) or a Bentall procedure (n=29), followed for a median duration of 34 months.
Zero late deaths occurred in either treatment cohort during the follow-up period.
Freedom from valve failure was 93.8% in the valve-sparing group and freedom from prosthesis dysfunction was 94.1% in the Bentall group, with neither cohort requiring reoperation.

Structured PICO

Does autograft valve-sparing procedure compared to Bentall procedure provide acceptable clinical outcomes in patients undergoing redo aortic root surgery post-Ross procedure?

Population

49 patients undergoing redo aortic root surgery for autograft dysfunction post-Ross procedure

Intervention

Autograft valve-sparing procedures (VSP)

Comparator

Bentall procedure (BP) (root replacement)

Outcome

Short and long-term clinical outcomes and echocardiographic results (including mortality, freedom from failure/dysfunction, and reoperation)hard clinical

Redo aortic root surgery post-Ross procedure can be safely performed using either valve-sparing or root replacement techniques, with excellent mid-term outcomes.

Implication

Supports either valve-sparing or Bentall redo root surgery post-Ross; leaves open long-term durability and comparative effectiveness.

Abstract

Background: Despite numerous advantages of the Ross procedure, it presents a risk of late autograft and right ventricular outflow tract conduit failure. This study aimed to analyze the outcomes of autograft dysfunction reoperations using autograft-sparing and root replacement techniques. Methods: Between 2015 and 2023, 49 patients underwent redo root surgery in our institution. Autograft valve-sparing procedures (VSP) were performed in 20 cases and the Bentall procedure (BP) in 29 patients. The short and long-term clinical outcomes along with echocardiographic results of VSP and BP were investigated. Results: = 0.04) were associated with a valve replacement procedure instead of VSP. The median follow-up duration was 34 months. No late deaths occurred in either group. Freedom from VSP failure and aortic prosthesis dysfunction were 93.8% and 94.1% in the VSP and BP groups, respectively. No reoperations were necessary in either group. Conclusion: Redo aortic root surgery can be safely performed in patients with autograft failure. Both root replacement and autograft valve-sparing procedures demonstrated acceptable results at mid-term follow-up. Early redo surgery pre-empting severe aortic insufficiency increases the likelihood of preservation of the dilated autograft valve.