The Ross procedure in adults presenting with bicuspid aortic valve and pure aortic regurgitation: 85% freedom from reoperation at 20 years

Poh, Chin L, Buratto, Edward, Larobina, Marco, Wynne, Rochelle, O'Keefe, Michael, Goldblatt, John, Tatoulis, James and Skillington, Peter D 2018, The Ross procedure in adults presenting with bicuspid aortic valve and pure aortic regurgitation: 85% freedom from reoperation at 20 years, European journal of cardio-thoracic surgery, vol. 54, no. 3, pp. 420-426, doi: 10.1093/ejcts/ezy073.

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Title The Ross procedure in adults presenting with bicuspid aortic valve and pure aortic regurgitation: 85% freedom from reoperation at 20 years
Author(s) Poh, Chin L
Buratto, Edward
Larobina, Marco
Wynne, Rochelle
O'Keefe, Michael
Goldblatt, John
Tatoulis, James
Skillington, Peter D
Journal name European journal of cardio-thoracic surgery
Volume number 54
Issue number 3
Start page 420
End page 426
Total pages 7
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2018-09
ISSN 1873-734X
Keyword(s) aortic valve replacement
aortic regurgitation
bicuspid aortic valve
Ross procedure
long-term survival
science & technology
life sciences & biomedicine
cardiac & cardiovascular systems
respiratory system
cardiovascular system & cardiology
Summary OBJECTIVES: The Ross procedure has demonstrated excellent results when performed in patients with aortic stenosis or mixed aortic valve disease [aortic stenosis and aortic regurgitation (AR)]. However, due to its reported risk of late reoperation, it is not recommended under current guidelines for patients presenting with bicuspid aortic valve and pure AR. We have analysed our own results in light of this recommendation. METHODS: Between 1993 and 2016, 129 consecutive patients with a mean age of 34.7 ± 10.6 years (range 16-64 years) presented with bicuspid aortic valve and pure AR and underwent the Ross procedure. Patients were reviewed annually and had 2nd yearly transthoracic echocardiograms during follow-up. The unit had a liberal reoperation policy where reoperation was performed if patients developed recurrent moderate or greater AR during follow-up. RESULTS: There was 1 inpatient death, and 3 late deaths over a mean follow-up duration of 9.6 ± 6.8 years. Late survival at 10 and 20 years post-surgery were 99% [95% confidence interval (CI) 94-100] and 95% (95% CI 85-99), respectively. Eleven patients underwent redo aortic valve replacement (AVR) and 4 patients had redo pulmonary valve replacement. Freedom from reoperation for AVR and more-than-mild AR at 10 and 20 years post-surgery were 89% (95% CI 81-94) and 85% (95% CI 74-92), respectively. Having longer aortic cross-clamp (hazard ratio 1.03, 95% CI 1.00-1.06; P = 0.05) and cardiopulmonary bypass times (hazard ratio 1.02, 95% CI 1.00-1.05; P = 0.05), and having a larger preoperative sinotubular junction diameter (hazard ratio 1.15, 95% CI 1.03-1.30; P = 0.02) were significant predictors of having redo AVR or significant AR at follow-up. CONCLUSIONS: With a 20-year freedom from redo AVR and greater-than-mild residual AR of 85%, the utilization of the Ross procedure in bicuspid aortic valve patients with pure AR should be considered.
Language eng
DOI 10.1093/ejcts/ezy073
Field of Research 1102 Cardiovascular Medicine And Haematology
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, The Authors
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Document type: Journal Article
Collections: Faculty of Health
Centre for Quality and Patient Safety Research
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