title: A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry†.
abstract: OBJECTIVE
  Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients.
  
  
  METHODS
  Between 1990-2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years.
  
  
  RESULTS
  The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years.
  
  
  CONCLUSIONS
  The autograft principle results in postoperative long-term survival comparable with that of the age- and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.
authors: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany hans-hinrich.sievers@uk-sh.de.
authors: Hans-Hinrich
authors: HH
authors: Sievers
authors: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors: Ulrich
authors: U
authors: Stierle
authors: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors: Efstratios I
authors: EI
authors: Charitos
authors: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
authors: Johanna J M
authors: JJ
authors: Takkenberg
authors: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors: Jürgen
authors: J
authors: Hörer
authors: Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.
authors: Rüdiger
authors: R
authors: Lange
authors: Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Ulrich
authors: U
authors: Franke
authors: Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Marc
authors: M
authors: Albert
authors: Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany.
authors: Armin
authors: A
authors: Gorski
authors: Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany.
authors: Rainer G
authors: RG
authors: Leyh
authors: Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany.
authors: Arlindo
authors: A
authors: Riso
authors: Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany.
authors: Jörg
authors: J
authors: Sachweh
authors: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany.
authors: Anton
authors: A
authors: Moritz
authors: Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.
authors: Roland
authors: R
authors: Hetzer
authors: Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany.
authors: Wolfgang
authors: W
authors: Hemmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation*; D012042:Registries; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic valve; Homograft; Pulmonary autograft; Ross procedure; Valve surgery