title: European multicenter experience with valve-sparing reoperations after the Ross procedure.
abstract: BACKGROUND
  Autograft valve preservation at reoperation may conserve some of the advantages of the Ross procedure. However, results of long-term follow-up are lacking. In this retrospective multicenter study, we present our experience with valve-sparing reoperations after the Ross procedure, with a focus on long-term outcome.
  
  
  METHODS
  A total of 86 patients from 6 European centers, who underwent valve-sparing reoperation after the Ross procedure between 1997 and 2013, were included in the study.
  
  
  RESULTS
  Reoperation was performed a median of 9.1 years after the Ross procedure in patients with a median age of 38.4 years (interquartile range: 27.1-51.6 years). Preoperative severe autograft regurgitation (grade ≥3) was present in 46% of patients. In-hospital mortality was 1%. During a median follow-up of 4.3 years, 3 more patients died of noncardiac causes, resulting in a cumulative survival at 8 years of 89% (95% confidence interval: 65%-97%). Fifteen patients required a reintervention after valve-sparing reoperation, mostly owing to prolapse or retraction of autograft cusps. Freedom from reintervention was 76% (95% confidence interval: 57%-87%) at 8 years. The reintervention hazard was increased in patients who had isolated and/or severe aortic regurgitation at valve-sparing reoperation. In patients without reintervention after valve-sparing autograft reoperation (n = 63), severe aortic regurgitation was present in 3% at last follow-up.
  
  
  CONCLUSIONS
  Valve-sparing autograft reoperations after the Ross procedure carry a low operative risk, with acceptable reintervention rates in the first postoperative decade. Patients with isolated and/or severe autograft regurgitation have an increased hazard of reintervention after valve-sparing reoperation; for these patients, careful preoperative weighing of surgical options is required.
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: a.mookhoek@erasmusmc.nl.
authors.forename: Aart
authors.initials: A
authors.lastname: Mookhoek
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: de Kerchove
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Gebrine
authors.initials: G
authors.lastname: El Khoury
authors.affiliation: Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Weimar
authors.affiliation: Division of Cardiac Surgery, University of Verona, Verona, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Luciani
authors.affiliation: Division of Cardiac Surgery, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.affiliation: Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg, Germany.
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.affiliation: Saarland University Medical Center, Department of Thoracic and Cardiovascular Surgery, Homburg, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Charitos
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.affiliation: Department of Cardio-thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ross procedure; follow-up; reoperation; valve-sparing