Key result
Valve-sparing operations after a previous Ross procedure achieve ~92% survival at 10 years.
Why the study?
Although the Ross procedure demonstrates excellent long-term results, reintervention can occur, prompting the need to describe institutional experience with redo surgery following previous Ross procedures.
Cohort (n=63)
No
Valve-sparing root replacements and aortic valve repair after a previous Ross procedure demonstrate excellent long-term survival and freedom from reoperation, supporting an aggressive valve-sparing approach.
Background: The Ross procedure has demonstrated excellent long-term results, with restoration of life-expectancy in patients with severe aortic valve dysfunction. However, reintervention after Ross can occur, and herein we describe our center's experience with redo surgery after previous Ross procedures. Methods: We searched our prospective database for aortic valve-repair and recruited all adult (≥18 years) patients who have undergone valve-sparing root replacements (VSRRs) and/or aortic valve-repair after Ross procedure between July 2001 and July 2022. Univariable logistic regression analysis was performed to identify variables affecting early mortality. Survival, freedom-from-valve-reintervention and freedom-from-aortic regurgitation (AR) grade ≥3 were analyzed with the Kaplan-Meier method. Results: A total of 63 patients were recruited for this study. Indication for reoperation after Ross was aortic aneurysm without AR in 17 (27%), aortic aneurysm with AR in 27 (43%), and isolated AR in 19 (30%) patients. Median follow-up time was 7.82 years. The majority of patients (76%) had undergone the free root technique during their index Ross operation. Cumulative survival, after redo surgery following Ross, was 98.4% [95% confidence interval (CI): 89.3-99.8%] at 1 year, 96.3% (95% CI: 88.2-98.3%) at 5 years, and 92.4% (95% CI: 87.1-98.0%) at 10 years. Freedom-from-reoperation on the aortic valve at 1 year was 98.4% (95% CI: 97.0-99.8%), at 5 years was 96.7% (95% CI: 87.6-99.0%), and 79.7% (95% CI: 71.1-88.3%) at 10 years. Conclusions: Long-term survival after redo surgery following the Ross operation is excellent. The data support our aggressive valve-sparing approach after Ross.
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Jahanyar et al. (2023) conducted a cohort in Aortic valve dysfunction after previous Ross procedure (n=63). Valve-sparing operations (remodeling, reimplantation, and/or aortic valve repair) was evaluated on Cumulative survival at 10 years (95% CI 87.1-98.0). Valve-sparing operations after a previous Ross procedure demonstrated excellent long-term outcomes, with a 10-year cumulative survival of 92.4% and a 10-year freedom from reoperation of 79.7%.
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