Document Detail

Autograft reinforcement to preserve autograft function after the ross procedure: a report from the german-dutch ross registry.
MedLine Citation:
PMID:  19752360     Owner:  NLM     Status:  MEDLINE    
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.
Efstratios I Charitos; Thorsten Hanke; Ulrich Stierle; Derek R Robinson; Ad J J C Bogers; Wolfgang Hemmer; Matthias Bechtel; Martin Misfeld; Armin Gorski; Juergen O Boehm; Joachim G Rein; Cornelius A Botha; Ruediger Lange; Juergen Hoerer; Anton Moritz; Thorsten Wahlers; Ulrich F W Franke; Martin Breuer; Katharina Ferrari-Kuehne; Roland Hetzer; Michael Huebler; Gerhard Ziemer; Johanna J M Takkenberg; Hans H Sievers;
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-15     Completed Date:  2009-10-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S146-54     Citation Subset:  AIM; IM    
Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Germany.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aortic Valve / transplantation*
Aortic Valve Insufficiency / surgery
Cardiac Surgical Procedures / methods*
Middle Aged
Proportional Hazards Models
Transplantation, Autologous

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  The complete supraannular concept: in vivo hemodynamics of bovine and porcine aortic bioprostheses.
Next Document:  Outcomes of patients undergoing concomitant aortic and mitral valve surgery in northern new England.