Ross procedure is a safe treatment option for aortic valve endocarditis: Long-term follow-up of 42 patients.
BACKGROUND
Aortic root replacement with a pulmonary autograft (Ross procedure) can be performed as a treatment of aortic valve endocarditis, avoiding prosthetic valve implantation in septic context. We sought to assess long-term outcomes of the Ross procedure in this indication.


METHODS
From April 1992 to March 2009, the intervention was performed in 42 patients (mean age 34 ± 8 years) suffering from an active or ancient aortic valve endocarditis. 36% of the patients had extensive perivalvular involvement, and surgery was urgent in 18 patients (43%). We performed a prospective clinical and echocardiographic follow-up of this population.


RESULTS
Median follow-up was 10 years (4-21 years). Overall survival at 10 and 15 years was respectively 87 ± 5% and 81 ± 8%. Perioperative mortality was 4.7% (2 patients) and no late cardiac death was reported. Eight patients (19%) underwent repeat surgery for autograft and/or homograft dysfunction at a median time of 8.4 years (3 months-18 years). Rate of recurrent endocarditis was low (7%-3 patients), including 1 in a context of persistent intravenous drug abuse. Clinical follow-up showed good functional status for all patients with NYHA ≤ II, and less than 25% of patients requiring cardiovascular medication. Late echocardiographic follow-up demonstrated well-functioning autograft and homograft, with only one severe aortic regurgitation, and one significant increase in pulmonary mean gradient.


CONCLUSIONS
The Ross procedure in aortic valve endocarditis is an interesting alternative to prosthetic valvular replacement in a selected population, with a high rate of survival free from any cardiovascular event or medication requirement.
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France. Electronic address: asvringle@gmail.com.
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Ringle
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France.
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Richardson
Department of Cardiovascular Surgery, CHU Lille, F-59000 Lille, France; INSERM UMR 1011, F-59000, Lille, France.
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Juthier
Department of Cardiovascular Surgery, CHU Lille, F-59000 Lille, France; INSERM UMR 1011, F-59000, Lille, France.
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Rousse
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France.
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Polge
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France; INSERM UMR 1011, F-59000, Lille, France.
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Coisne
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France.
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Duva-Pentiah
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France.
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Ben Abda
Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland.
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Banfi
Department of Cardiovascular Explorations, CHU Lille, F-59000 Lille, France; INSERM UMR 1011, F-59000, Lille, France.
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Montaigne
Department of Cardiovascular Surgery, CHU Lille, F-59000 Lille, France; INSERM UMR 1011, F-59000, Lille, France.
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Vincentelli
Department of Cardiovascular Surgery, CHU Lille, F-59000 Lille, France.
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Prat
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004697:Endocarditis, Bacterial / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation*; D013997:Time Factors; D014182:Transplantation, Autologous; D055815:Young Adult
Aortic valve surgery; Echocardiography; Endocarditis; Ross procedure; Valve repair