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Ross Root Dilation in Adult Patients: Is Preoperative Aortic Insufficiency Associated With Increased Late Autograft Reoperation?
MedLine Citation:
PMID:  21620370     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
John W Brown; John W Fehrenbacher; Mark Ruzmetov; Ali Shahriari; Jacob Miller; Mark W Turrentine
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-25
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Section of Cardiothoracic Surgery, Indiana University School of Medicine, and Methodist Hospital, Indianapolis, Indiana.
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