Valve performance classification in 630 subcoronary Ross patients over 22 years

The Journal of Thoracic and Cardiovascular Surgery

Ulrich Stierle¹  Hans-Hinrich Sievers² 

[1] Department of Cardiac Surgery, Halle-Wittenberg University, Halle (Saale), Germany;Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

关键词: valve performance classification;    Ross procedure;    subcoronary technique;    long-term data;    hemodynamics;   

DOI  :  10.1016/j.jtcvs.2018.03.015

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo define the function of the "Ross valves" and its clinical meaning in a practical valve performance classification as part of the outcome analysis.MethodsFrom 1994 to 2017, 630 consecutive patients underwent the subcoronary Ross procedure at our institution. The valve performance classification combines hemodynamics, symptoms, and management criteria. Median follow-up was 12.5 years (maximum 22.3 years, 7404 patient-years, 99.4% completeness).ResultsThe mean age of the patients was 44.7 ± 11.9 years. Hospital deaths was 0.3% (n = 2). Twenty years after the operation survival was 73.1% (95% confidence interval [CI], 65.4%-81.6%) and statistically not different from the age- and gender-matched general population; freedom from reoperation was 85.9% (95% CI, 80.2%-92.0%; 0.6% per patient-year), 89.8% (95% CI, 84.3%-95.7%) for autograft, and 91.0% (95% CI, 86.3%-96.0%) for homograft. Preoperative annulus diameter, aortic regurgitation, annulus reinforcement, sinotubular junction reinforcement, and bicuspid aortic valve type were no significant risk factors for reoperation. At 20 years the probability of a patient being in valve performance class I to IV was 5%, 74%, 19%, and 1%, respectively. Time to reoperation was not different in bicuspid and tricuspid aortic valves; preoperative aortic stenosis tended to have better outcome of autograft function.ConclusionsThese up to 22 years data show that the subcoronary Ross procedure continues to provide an excellent tissue aortic valve replacement. The suggested valve performance classification emerged as a practical concept for outcome analysis with the probability of 79% being in the favorable class I or II at 20 years.

【 授权许可】

Unknown