title: 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.
  
  
  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.
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Germany.
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hanke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Derek R
authors.initials: DR
authors.lastname: Robinson
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hemmer
authors.forename: Matthias
authors.initials: M
authors.lastname: Bechtel
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.forename: Armin
authors.initials: A
authors.lastname: Gorski
authors.forename: Juergen O
authors.initials: JO
authors.lastname: Boehm
authors.forename: Joachim G
authors.initials: JG
authors.lastname: Rein
authors.forename: Cornelius A
authors.initials: CA
authors.lastname: Botha
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.forename: Juergen
authors.initials: J
authors.lastname: Hoerer
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Ulrich F W
authors.initials: UF
authors.lastname: Franke
authors.forename: Martin
authors.initials: M
authors.lastname: Breuer
authors.forename: Katharina
authors.initials: K
authors.lastname: Ferrari-Kuehne
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Michael
authors.initials: M
authors.lastname: Huebler
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ziemer
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Hans H
authors.initials: HH
authors.lastname: Sievers
mesh_terms: 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