title: Reoperations on the pulmonary autograft and pulmonary homograft after the Ross procedure: An update on the German Dutch Ross Registry.
abstract: OBJECTIVE
  Reinterventions after the Ross procedure are a concern for patients and treating physicians. The scope of the present report was to provide an update on the reinterventions observed in the large patient population of the German-Dutch Ross Registry.
  
  
  METHODS
  From 1988 to 2011, 2023 patients (age, 39.05 ± 16.5 years; male patients, 1502; adults, 1642) underwent a Ross procedure in 13 centers. The mean follow-up was 7.1 ± 4.6 years (range, 0-22 years; 13,168 patient-years).
  
  
  RESULTS
  In the adult population, 120 autograft reinterventions in 113 patients (1.03%/patient-year) and 76 homograft reinterventions in 67 patients (0.65%/patient-year) and, in the pediatric population, 14 autograft reinterventions in 13 patients (0.91%/patient-year) and 42 homograft reinterventions in 31 patients (2.72%/patient-year) were observed. Of the autograft and homograft reinterventions, 17.9% and 21.2% were performed because of endocarditis, respectively. The subcoronary technique in the adult population resulted in significantly superior autograft durability (freedom from autograft reintervention: 97% at 10 years and 91% at 12 years; P < .001). The root replacement technique without root reinforcement (hazard ratio, 2.4; 95% confidence interval, 1.4-4.1) and the presence of pure aortic insufficiency preoperatively (hazard ratio, 2.3; 95% confidence interval, 1.5-3.5) were statistically significant predictors for a shorter time to reoperation. The center volume had a significant influence on the long-term results. The freedom from homograft reoperation for the adults and pediatric population was 97% and 87% at 5 years and 93% and 79% at 12 years, respectively (P < .001), with younger recipient and donor age being significant predictors of a shorter time to homograft reoperation.
  
  
  CONCLUSIONS
  The autograft principle remains a valid option for young patients requiring aortic valve replacement. The risk of reoperation depends largely on the surgical technique used and the preoperative hemodynamics. Center experience and expertise also influence the long-term results. Adequate endocarditis prophylaxis might further reduce the need for reoperation.
authors.affiliation: University of Luebeck, Luebeck, Germany. efstratios.charitos@gmail.com
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hanke
authors.forename: Armin
authors.initials: A
authors.lastname: Gorski
authors.forename: Cornelius
authors.initials: C
authors.lastname: Botha
authors.forename: Ulrich
authors.initials: U
authors.lastname: Franke
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.forename: Juergen
authors.initials: J
authors.lastname: Hoerer
authors.forename: Rudiger
authors.initials: R
authors.lastname: Lange
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
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: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hemmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000637:transplantation*; D011664:Pulmonary Valve / Q000637:transplantation*; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult