Ross root dilation in adult patients: Is preoperative aortic insufficiency associated with increased late autograft reoperation?

John Brown, John W. Fehrenbacher, Mark Ruzmetov, Ali Shahriari, Jacob Miller, Mark Turrentine

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: The Ross aortic valve replacement (AVR) offers excellent hemodynamic and clinical outcomes in most patients undergoing aortic root replacement. Because of ongoing debate regarding the durability of this procedure, long-term follow-up in a large adult Ross experience might be of interest. Methods: Between 1994 and 2010, 230 adult patients underwent modified Ross root procedures. Mean age was 42.4 ± 12.1 years (range, 20 to 68 years), 62% were male. Fifty-six patients (24%) had undergone one or more prior aortic valve interventions. Concomitant procedures were performed in 126 patients (55%), including 90 ascending aortic procedures. Presenting pathology was aortic insufficiency in 114 (50%) and aortic stenosis in 116 (50%). Results: Hospital mortality or within 30 days was 2 of 230 patients (0.9%). During follow-up (mean, 7.8 years), 12 more patients died. At 15 years, survival was 94%, and freedom from autograft and allograft reoperation was 91% and 98%, respectively. Reoperation was required for 23 patients. Eighteen patients required reoperation on the autograft root; 11 of 18 (61%) had preoperative aortic insufficiency as their predominate aortic valve lesion. Freedom from autograft reoperation was not significantly different for patients with preoperative aortic insufficiency (87%) compared with patients who had aortic stenosis (94%; p = 0.15). On multivariable analysis, no risk factors were significant for reoperation except for surgery before 2000 (p < 0.0001) and previous AVR (p = 0.05). Conclusions: Preoperative aortic regurgitation was not a significant risk factor for late autograft reoperation in adults. The Ross AVR provides excellent hemodynamics and survival for adults willing to accept a small risk of reoperation as opposed to a life-long risk of thromboemboli and anticoagulation therapy as exist with mechanical aortic prostheses. Reoperation risk for Ross AVR has decreased with Ross annulus sinotubular junction reinforcement replacement of a dilated ascending aorta and postoperative hypertension management.

Original languageEnglish
Pages (from-to)74-81
Number of pages8
JournalAnnals of Thoracic Surgery
Volume92
Issue number1
DOIs
StatePublished - Jul 2011

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Autografts
Reoperation
Dilatation
Aortic Valve
Aortic Valve Stenosis
Hemodynamics
Survival
Aortic Valve Insufficiency
Hospital Mortality
Prostheses and Implants
Allografts
Aorta
Pathology
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Ross root dilation in adult patients : Is preoperative aortic insufficiency associated with increased late autograft reoperation? / Brown, John; Fehrenbacher, John W.; Ruzmetov, Mark; Shahriari, Ali; Miller, Jacob; Turrentine, Mark.

In: Annals of Thoracic Surgery, Vol. 92, No. 1, 07.2011, p. 74-81.

Research output: Contribution to journalArticle

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title = "Ross root dilation in adult patients: Is preoperative aortic insufficiency associated with increased late autograft reoperation?",
abstract = "Background: The Ross aortic valve replacement (AVR) offers excellent hemodynamic and clinical outcomes in most patients undergoing aortic root replacement. Because of ongoing debate regarding the durability of this procedure, long-term follow-up in a large adult Ross experience might be of interest. Methods: Between 1994 and 2010, 230 adult patients underwent modified Ross root procedures. Mean age was 42.4 ± 12.1 years (range, 20 to 68 years), 62{\%} were male. Fifty-six patients (24{\%}) had undergone one or more prior aortic valve interventions. Concomitant procedures were performed in 126 patients (55{\%}), including 90 ascending aortic procedures. Presenting pathology was aortic insufficiency in 114 (50{\%}) and aortic stenosis in 116 (50{\%}). Results: Hospital mortality or within 30 days was 2 of 230 patients (0.9{\%}). During follow-up (mean, 7.8 years), 12 more patients died. At 15 years, survival was 94{\%}, and freedom from autograft and allograft reoperation was 91{\%} and 98{\%}, respectively. Reoperation was required for 23 patients. Eighteen patients required reoperation on the autograft root; 11 of 18 (61{\%}) had preoperative aortic insufficiency as their predominate aortic valve lesion. Freedom from autograft reoperation was not significantly different for patients with preoperative aortic insufficiency (87{\%}) compared with patients who had aortic stenosis (94{\%}; p = 0.15). On multivariable analysis, no risk factors were significant for reoperation except for surgery before 2000 (p < 0.0001) and previous AVR (p = 0.05). Conclusions: Preoperative aortic regurgitation was not a significant risk factor for late autograft reoperation in adults. The Ross AVR provides excellent hemodynamics and survival for adults willing to accept a small risk of reoperation as opposed to a life-long risk of thromboemboli and anticoagulation therapy as exist with mechanical aortic prostheses. Reoperation risk for Ross AVR has decreased with Ross annulus sinotubular junction reinforcement replacement of a dilated ascending aorta and postoperative hypertension management.",
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