Long-term results of the Ross operation in adults
Abstract
Aim. To analyze the
experience of performing the Ross procedure in adult patients.
Material and methods.
The retrospective study included 206 patients with AK pathology [154 men
(74.8%)/52 women (25.2%)]. Inclusion criteria: patients who underwent the Ross
operation from 2009 to 2019, the patient’s age is 18 years and older. Exclusion
criteria none. The median age was 35 [26–44] years. Infective endocarditis as
an AV dysfunction was diagnosed in 56 (27.2%) patients, and bicuspid AV in 125
(60.7%) patients. The median follow-up period was 94 [42–115] months.
Results. Combined
interventions were performed in 38 (18.4%) cases. Modified techniques were
applied in 23.3% of cases. The median duration of surgery was 220 [195–255]
min, cardiopulmonary bypass – 138 [123–155] min, myocardial ischemia 115
[103–127] min. Hospital mortality was 0.5%. In the early postoperative period,
implantation of a permanent pacemaker was indicated in 5 (2.4%) patients due to
conduction disturbances. 9 (4.4%) patients developed perioperative myocardial
injury, the number of strokes was 2 (1%). Ten-year overall survival, freedom
from reoperation on a pulmonary autograft, freedom from reoperation on a
pulmonary homograft was 95.6%, 87.8%, 96.5%, respectively. By the end of the
observation period, the median of the peak and mean gradient on the lung
autograft was 6 [4–8] and 3 [2–5] mm Hg and aortic regurgitation ≥2 degree was
detected in 34 (17.8%) patients.
Conclusion.
The Ross procedure is a safe alternative to AV replacement if performed by
experienced specialists with acceptably low in-hospital mortality and excellent
long-term outcomes.
Keywords:aortic stenosis; aortic regurgitation; acquired heart disease; aortic valve replacement; aortic valve; Ross operation
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Chernov I.I., Enginoev S.T., Аbdulmedzhidova U.K.,
Ziankou A.A., Gamzaev A.B. Long-term results of the Ross operation in adults.
Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (2): 85–92. DOI:
https://doi.org/10.33029/2308-1198-2023-11-2-85-92
(in Russian)
References
1. Sénage T., Gillaizeau F., Le Tourneau T., Marie B., Roussel J.-C., Foucher Y. Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication // J. Thorac. Cardiovasc. Surg. 2019. Vol. 157. P. 1383-1390.e5. DOI: https://doi.org/10.1016/j.jtcvs.2018.08.086
2. Ross D.N. Replacement of aortic and mitral valves with a pulmonary autograft // Lancet. 1967. Vol. 2. P. 956-958. DOI: https://doi.org/10.1016/s0140-6736(67)90794-5
3. Reece T.B., Welke K.F., O’Brien S., Grau-Sepulveda M.V., Grover F.L., Gammie J.S. Rethinking the ross procedure in adults // Ann. Thorac. Surg. 2014. Vol. 97. P. 175-181. DOI: https://doi.org/10.1016/j.athoracsur.2013.07.036
4. David T.E., David C., Woo A., Manlhiot C. The Ross procedure: Outcomes at 20 years // J. Thorac. Cardiovasc. Surg. 2014. Vol. 147. P. 85-93. DOI: https://doi.org/10.1016/j.jtcvs.2013.08.007
5. Skillington P.D., Mokhles M.M., Takkenberg J.J.M., Larobina M., O’Keefe M., Wynne R. et al. The Ross procedure using autologous support of the pulmonary autograft: Techniques and late results // J. Thorac. Cardiovasc. Surg. 2015. Vol. 149. P. S46-S52. DOI: https://doi.org/https://doi.org/10.1016/j.jtcvs.2014.08.068
6. Mastrobuoni S., de Kerchove L., Solari S., Astarci P., Poncelet A., Noirhomme P. et al. The Ross procedure in young adults: over 20 years of experience in our Institution // Eur. J. Cardiothorac. Surg. 2016. Vol. 49. P. 507-513. DOI: https://doi.org/10.1093/ejcts/ezv053
7. Martin E., Mohammadi S., Jacques F., Kalavrouziotis D., Voisine P., Doyle D. et al. Clinical outcomes following the ross procedure in adults: A 25-year longitudinal study // J. Am. Coll. Cardiol. 2017. Vol. 70. P. 1890-1899. DOI: https://doi.org/10.1016/j.jacc.2017.08.030
8. Mazine A., Rocha R.V., El-Hamamsy I., Ouzounian M., Yanagawa B., Bhatt D.L. et al. Ross procedure vs mechanical aortic valve replacement in adults: A systematic review and meta-analysis // JAMA Cardiol. 2018. Vol. 3. P. 978-987. DOI: https://doi.org/10.1001/jamacardio.2018.2946
9. McClure G.R., Belley-Cote E.P., Um K., Gupta S., Bouhout I., Lortie H. et al. The Ross procedure versus prosthetic and homograft aortic valve replacement: A systematic review and meta-analysis // Eur. J. Cardiothorac. Surg. 2019. Vol. 55. P. 247-255. DOI: https://doi.org/10.1093/ejcts/ezy247
10. Etnel J.R.G., Grashuis P., Huygens S.A., Pekbay B., Papageorgiou G., Helbing W.A. et al. The Ross procedure: A systematic review, meta-analysis, and microsimulation // Circ. Cardiovasc. Qual. Outcomes. 2018. Vol. 11. Article ID e004748. DOI: https://doi.org/10.1161/CIRCOUTCOMES.118.004748
11. El-Hamamsy I., Eryigit Z., Stevens L.-M., Sarang Z., George R., Clark L. et al. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: A randomised controlled trial // Lancet. 2010. Vol. 376. P. 524-531. DOI: https://doi.org/10.1016/S0140-6736(10)60828-8
12. Otto C.M., Nishimura R.A., Bonow R.O., Carabello B.A., Erwin J.P. 3rd, Gentile F. et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines // Circulation. 2021. Vol. 143. P. e35-e71. DOI: https://doi.org/10.1161/CIR.0000000000000932
13. Bourguignon T., Bouquiaux-Stablo A.-L., Candolfi P., Mirza A., Loardi C., May M.-A. et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position // Ann. Thorac. Surg. 2015. Vol. 99. P. 831-837. DOI: https://doi.org/10.1016/j.athoracsur.2014.09.030
14. Bouhout I., Stevens L.-M., Mazine A., Poirier N., Cartier R., Demers P. et al. Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults // J. Thorac. Cardiovasc. Surg. 2014. Vol. 148. P. 1341-1346.e1. DOI: https://doi.org/10.1016/j.jtcvs.2013.10.064
15. Mazine A., David T.E., Rao V., Hickey E.J., Christie S., Manlhiot C. et al. Long-term outcomes of the ross procedure versus mechanical aortic valve replacement: Propensity-matched cohort study // Circulation. 2016. Vol. 134. P. 576-585. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.022800
16. Mazine A., El-Hamamsy I., Verma S., Peterson M.D., Bonow R.O., Yacoub M.H. et al. Ross procedure in adults for cardiologists and cardiac surgeons: JACC state-of-the-art review // J. Am. Coll. Cardiol. 2018. Vol. 72. P. 2761-2777. DOI: https://doi.org/10.1016/j.jacc.2018.08.2200
17. Sibilio S., Koziarz A., Belley-Côté E.P., McClure G.R., MacIsaac S., Reza S.J. et al. Outcomes after Ross procedure in adult patients: A meta-analysis and microsimulation // J. Card. Surg. 2019. Vol. 34. P. 285-292. DOI: https://doi.org/10.1111/jocs.14020
18. Tsaroev B., Chernov I., Enginoev S., Mustaev M. Survival and freedom from reoperation after the Ross procedure in a Russian adult population: A single-center experience // JTCVS Open. 2022. Vol. 10. P. 140-147. DOI: https://doi.org/10.1016/j.xjon.2022.04.026
19. Bouhout I., Noly P.-E., Ghoneim A., Stevens L.-M., Cartier R., Poirier N. et al. Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement in a propensity-matched cohort // Interact. Cardiovasc. Thorac. Surg. 2017. Vol. 24. P. 41-47. DOI: https://doi.org/10.1093/icvts/ivw325
20. Aboud A., Charitos E.I., Fujita B., Stierle U., Reil J.C., Voth V. et al. Long-term outcomes of patients undergoing the Ross procedure // J. Am. Coll. Cardiol. 2021. Vol. 77. P. 1412-1422. DOI: https://doi.org/10.1016/j.jacc.2021.01.034
21. Um K.J., Mcclure G.R., Belley-Cote E.P., Gupta S., Bouhout I., Lortie H. et al. Hemodynamic outcomes of the Ross procedure versus other aortic valve replacement: A systematic review and meta-analysis // J. Cardiovasc. Surg. (Torino). 2018. Vol. 59. P. 462-470. DOI: https://doi.org/10.23736/S0021-9509.18.10255-2
22. Duebener L.F., Stierle U., Erasmi A., Bechtel M.F., Zurakowski D., Böhm J.O. et al. Ross procedure and left ventricular mass regression // Circulation. 2005. Vol. 112. P. I415-I422. DOI: https://doi.org/10.1161/CIRCULATIONAHA.104.525444
23. Chan V., Rubens F., Boodhwani M., Mesana T., Ruel M. Determinants of persistent or recurrent congestive heart failure after contemporary surgical aortic valve replacement // J. Heart Valve Dis. 2014. Vol. 23. P. 665-670.
24. Bouhout I., Ghoneim A., Tousch M., Stevens L.M., Semplonius T., Tarabzoni M. et al. Impact of a tailored surgical approach on autograft root dimensions in patients undergoing the Ross procedure for aortic regurgitation // Eur. J. Cardiothorac. Surg. 2019. Vol. 56. P. 959-967. DOI: https://doi.org/10.1093/ejcts/ezz105
25. David T.E., Woo A., Armstrong S., Maganti M. When is the Ross operation a good option to treat aortic valve disease? // J. Thorac. Cardiovasc. Surg. 2010. Vol. 139. P. 65-68. DOI: https://doi.org/10.1016/j.jtcvs.2009.09.053
26. Lansac E., Di Centa I., Sleilaty G., Lejeune S., Khelil N., Berrebi A. et al. Long-term results of external aortic ring annuloplasty for aortic valve repair // Eur. J. Cardiothorac. Surg. 2016. Vol. 50. P. 350-360. DOI: https://doi.org/10.1093/ejcts/ezw070
27. Youssefi P., El-Hamamsy I., Lansac E. Rationale for aortic annuloplasty to standardise aortic valve repair // Ann. Cardiothorac. Surg. 2019. Vol. 8. P. 322-330. DOI: https://doi.org/10.21037/acs.2019.05.13
28. Basmadjian L., Basmadjian A.J., Stevens L.-M., Mongeon F.-P., Cartier R., Poirier N. et al. Early results of extra-aortic annuloplasty ring implantation on aortic annular dimensions // J. Thorac. Cardiovasc. Surg. 2016. Vol. 151. P. 1280-1285.e1. DOI: https://doi.org/https://doi.org/10.1016/j.jtcvs.2015.12.014
29. Chernov I.I., Enginoev S.T., Kondrat’ev D.A., Koz’min D.Yu., Demetskaya V.V., Aliev E.R., et al. Five-year outcomes of the modified Ross surgery in adults: experience from one center. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2021; 25 (3): 43-50. DOI: http://dx.doi.org/10.21688/1681-3472-2021-3-43-50 (in Russian) [Чернов И.И., Энгиноев С.Т., Кондратьев Д.А., Козьмин Д.Ю., Демецкая В.В., Алиев Э.Р. и др. Пятилетние результаты модифицированной операции Росса у взрослых: опыт одного центра // Патология кровообращения и кардиохирургия. 2021. Т. 25, № 3. С. 43-50. DOI: http://dx.doi.org/10.21688/1681-3472-2021-3-43-50]