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Autograft reinforcement to preserve autograft function after the ross procedure: a report from the german-dutch ross registry.

Abstract：

BACKGROUND:Autograft reinforcement interventions (R) during the Ross procedure are intended to preserve autograft function and improve durability. The aim of this study is to evaluate this hypothesis. METHODS AND RESULTS:1335 adult patients (mean age:43.5+/-12.0 years) underwent a Ross procedure (subcoronary, SC, n=637; root replacement, Root, n=698). 592 patients received R of the annulus, sinotubular junction, or both. Regular clinical and echocardiographic follow-up was performed (mean:6.09+/-3.97, range:0.01 to 19.2 years). Longitudinal assessment of autograft function with time was performed using multilevel modeling techniques. The Root without R (Root-R) group was associated with a 6x increased reoperation rate compared to Root with R (Root+R), SC with R (SC+R), and without R (SC-R; 12.9% versus 2.3% versus 2.5%.versus 2.6%, respectively; P<0.001). SC and Root groups had similar rate of aortic regurgitation (AR) development over time. Root+R patients had no progression of AR, whereas Root-R had 6 times higher AR development compared to Root+R. In SC, R had no remarkable effect on the annual AR progression. The SC technique was associated with lower rates of autograft dilatation at all levels of the aortic root compared to the Root techniques. R did not influence autograft dilatation rates in the Root group. CONCLUSIONS:For the time period of the study surgical autograft stabilization techniques preserve autograft function and result in significantly lower reoperation rates. The nonreinforced Root was associated with significant adverse outcome. Therefore, surgical stabilization of the autograft is advisable to preserve long-term autograft function, especially in the Root Ross procedure.

journal_name

Circulation

journal_title

Circulation

authors

Charitos EI,Hanke T,Stierle U,Robinson DR,Bogers AJ,Hemmer W,Bechtel M,Misfeld M,Gorski A,Boehm JO,Rein JG,Botha CA,Lange R,Hoerer J,Moritz A,Wahlers T,Franke UF,Breuer M,Ferrari-Kuehne K,Hetzer R,Huebler M,Ziem

doi

10.1161/CIRCULATIONAHA.108.843391

subject

Has Abstract

pub_date

2009-09-15 00:00:00

pages

S146-54

issue

11 Suppl

eissn

0009-7322

issn

1524-4539

pii

120/11_suppl_1/S146

journal_volume

120

pub_type

杂志文章

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Autograft reinforcement to preserve autograft function after the ross procedure: a report from the german-dutch ross registry.