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


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.
Charitos
Efstratios I
EI
Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Germany.
Hanke
Thorsten
T
Stierle
Ulrich
U
Robinson
Derek R
DR
Bogers
Ad J J C
AJ
Hemmer
Wolfgang
W
Bechtel
Matthias
M
Misfeld
Martin
M
Gorski
Armin
A
Boehm
Juergen O
JO
Rein
Joachim G
JG
Botha
Cornelius A
CA
Lange
Ruediger
R
Hoerer
Juergen
J
Moritz
Anton
A
Wahlers
Thorsten
T
Franke
Ulrich F W
UF
Breuer
Martin
M
Ferrari-Kuehne
Katharina
K
Hetzer
Roland
R
Huebler
Michael
M
Ziemer
Gerhard
G
Takkenberg
Johanna J M
JJ
Sievers
Hans H
HH
D000328:Adult; D001021:Aortic Valve / Q000637:transplantation*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D014182:Transplantation, Autologous