Autograft and pulmonary allograft performance in the second post-operative decade after the Ross procedure: insights from the Rotterdam Prospective Cohort Study.
OBJECTIVE
The objective of the present study was to report our ongoing prospective cohort of autograft recipients with up to 21 years of follow-up.


RESULTS
All consecutive patients (n = 161), operated between 1988 and 2010, were analysed. Mixed-effects models were used to assess changes in echocardiographic measurements (n = 1023) over time in both the autograft and the pulmonary allograft. The mean patient age was 20.9 years (range 0.05-52.7)-66.5% were male. Early mortality was 2.5% (n = 4), and eight additional patients died during a mean follow-up of 11.6 ± 5.7 years (range 0-21.5). Patient survival was 90% [95% confidence interval (CI), 78-95] up to 18 years. During the follow-up, 57 patients required a re-intervention related to the Ross operation. Freedom from autograft reoperation and allograft re-intervention was 51% (95% CI 38-63) and 82% (95% CI 71-89) after 18 years, respectively. No major changes were observed over time in autograft gradient, and allograft gradient and regurgitation. An initial increase of sinotubular junction and aortic anulus diameter was observed in the first 5 years after surgery. The only factor associated with an increased autograft reoperation rate was pre-operative pure aortic regurgitation (AR) (hazard ratio 1.88; 95% CI 1.04-3.39; P= 0.037).


CONCLUSIONS
We observed good late survival in patients undergoing autograft procedure without reinforcement techniques. However, over half of the autografts failed prior to the end of the second decade. The reoperation rate and the results of echocardiographic measurements over time underline the importance of careful monitoring especially in the second decade after the initial autograft operation and in particular in patients with pre-operative AR.
Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. m.mokhles@erasmusmc.nl
M Mostafa
MM
Mokhles
Dimitris
D
Rizopoulos
Eleni R
ER
Andrinopoulou
Jos A
JA
Bekkers
Jolien W
JW
Roos-Hesselink
Emmanuel
E
Lesaffre
Ad J J C
AJ
Bogers
Johanna J M
JJ
Takkenberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D055815:Young Adult