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LONG-TERM OUTCOMES OF THE ROSS PROCEDURE IN ADULTS: 15-YEAR SINGLE CENTRE EXPERIENCE
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Canadian Journal of Cardiology Volume 31 2015
compared to previously reported series. Freedom from aortic related events is very high as well as survival thus necessitating long-term follow-up.These results may impact current imaging guidelines in terms of interval between CTs and extent of aortic imaging.
418 LONG-TERM OUTCOMES OF THE ROSS PROCEDURE IN ADULTS: 15-YEAR SINGLE CENTRE EXPERIENCE WD Kent, SC Malaisrie, A Andrei, PW Fedak, J Kruse, Z Li, PM McCarthy Calgary, Alberta BACKGROUND:
In adults with aortic valve disease requiring valve replacement, we compared the long-term outcomes of the Ross procedure with those of alternative operations for aortic valve pathology. METHODS: A retrospective analysis was performed from a single center database between January 1987 and March 2002 for 569 patients undergoing aortic valve and root surgery. Using propensity score (PS) models adjusting for age, gender and aortic valve morphology, long-term outcomes of the Ross procedure were compared with 3 contemporary control groups of patients who underwent root replacement with a prosthetic valve conduit (RRVC, N¼125)), patients who underwent root replacement with a valve-sparing procedure (VSRR, N¼45) and patients who underwent standard aortic valve replacement (AVR, N¼395). End-points included 30day and all-cause long-term mortality at 15 years, as well as freedom from recurrent aortic regurgitation (AR) and from reoperation. RESULTS: The Ross procedure was performed in 49 patients, with 63% male gender and a mean age of 43 11. The majority presented as NYHA class I and II (73%). Sixty-Seven percent had bicuspid aortic valve morphology with pure AR in 55% and aortic stenosis (AS) or mixed AS and AR in 45%. Endocarditis accounted for 10% of the patients. Mean followup was 10 4 years in the Ross group and was 88% complete at 10 years. Early mortality after the Ross procedure was 6.1%, which compared with 0% for AVR, 0% for VSRR and 1% for RRVC. Eighteen patients required reoperation in the Ross group for recurrent AR, autograft root dilation and endocarditis. The reoperation rate per 10 person-years was 0.37, which was significantly higher than the rate of 0.07 in the control groups (Figure 1). After PS matching, Ross patients had higher long-term mortality than the control groups (18% vs. 5%). CONCLUSION: Although excellent results of the Ross procedure have been reported from high volume centers, these data suggest the long-term durability of this operation may be inferior to alternative procedures for aortic valve and root pathology.
419 EARLY RESULTS AND MID-TERM DURABILITY OF AORTIC ANNULAR DIMENSIONS AND DYNAMICS FOLLOWING EXTRAAORTIC ANNULOPLASTY RING IMPLANTATION L Basmadjian, A Basmadjian, L Stevens, N Poirier, R Cartier, I El-Hamamsy Montréal, Québec INTRODUCTION:
Dilatation of the aortic annulus is a cause of recurrent aortic regurgitation (AR) following aortic root reconstructive procedures. The use of an extra-aortic annuloplasty ring is a novel and potentially useful adjunct to mitigate that risk. The aim of this study was to analyze the early effectiveness and mid-term stability of this surgical technique. METHODS: From 2011 to 2015, 50 patients (mean age 4016 years) underwent adjunct extra-aortic annuloplasty ring implantation (n¼39 Dacron rings and n¼11 ExAo Coroneo rings). Median ring size was 28mm (range 27-32mm). All patients had preoperative aortic regurgitation and/or a dilated aortic annulus. The main surgical procedure was a valvesparing root remodeling procedure (n¼32) or a Ross procedure (n¼18). Preoperative, early postoperative and follow-up echocardiographic systolic and diastolic aortic annular dimensions were prospectively collected. Statistical analyses were performed using mixed effect models. Median follow-up was 2 years (100% complete). RESULTS: Use of an extra-aortic annuloplasty ring resulted in a significant decrease in both systolic (27.90.5mm preoperatively versus 23.60.3mm at discharge, p<0.001) and diastolic (24.80.4mm preoperatively versus 20.30.3mm at discharge, p<0.001) dimensions. Mid-term follow-up showed stability of the annular reduction. At 2 years, mean systolic and diastolic dimensions remained unchanged compared to their early postoperative values (24.40.3mm in systole and 22.1-.3mm in diastole, p¼NS versus at discharge). Systolic expansion of the annulus was conserved early after surgery (13,8% systolic expansion) and preserved up to 2 years after ring implantation (9,4% systolic expansion). No differences in
Canadian Journal of Cardiology Volume 31 2015
compared to previously reported series. Freedom from aortic related events is very high as well as survival thus necessitating long-term follow-up.These results may impact current imaging guidelines in terms of interval between CTs and extent of aortic imaging.
418 LONG-TERM OUTCOMES OF THE ROSS PROCEDURE IN ADULTS: 15-YEAR SINGLE CENTRE EXPERIENCE WD Kent, SC Malaisrie, A Andrei, PW Fedak, J Kruse, Z Li, PM McCarthy Calgary, Alberta BACKGROUND:
In adults with aortic valve disease requiring valve replacement, we compared the long-term outcomes of the Ross procedure with those of alternative operations for aortic valve pathology. METHODS: A retrospective analysis was performed from a single center database between January 1987 and March 2002 for 569 patients undergoing aortic valve and root surgery. Using propensity score (PS) models adjusting for age, gender and aortic valve morphology, long-term outcomes of the Ross procedure were compared with 3 contemporary control groups of patients who underwent root replacement with a prosthetic valve conduit (RRVC, N¼125)), patients who underwent root replacement with a valve-sparing procedure (VSRR, N¼45) and patients who underwent standard aortic valve replacement (AVR, N¼395). End-points included 30day and all-cause long-term mortality at 15 years, as well as freedom from recurrent aortic regurgitation (AR) and from reoperation. RESULTS: The Ross procedure was performed in 49 patients, with 63% male gender and a mean age of 43 11. The majority presented as NYHA class I and II (73%). Sixty-Seven percent had bicuspid aortic valve morphology with pure AR in 55% and aortic stenosis (AS) or mixed AS and AR in 45%. Endocarditis accounted for 10% of the patients. Mean followup was 10 4 years in the Ross group and was 88% complete at 10 years. Early mortality after the Ross procedure was 6.1%, which compared with 0% for AVR, 0% for VSRR and 1% for RRVC. Eighteen patients required reoperation in the Ross group for recurrent AR, autograft root dilation and endocarditis. The reoperation rate per 10 person-years was 0.37, which was significantly higher than the rate of 0.07 in the control groups (Figure 1). After PS matching, Ross patients had higher long-term mortality than the control groups (18% vs. 5%). CONCLUSION: Although excellent results of the Ross procedure have been reported from high volume centers, these data suggest the long-term durability of this operation may be inferior to alternative procedures for aortic valve and root pathology.
419 EARLY RESULTS AND MID-TERM DURABILITY OF AORTIC ANNULAR DIMENSIONS AND DYNAMICS FOLLOWING EXTRAAORTIC ANNULOPLASTY RING IMPLANTATION L Basmadjian, A Basmadjian, L Stevens, N Poirier, R Cartier, I El-Hamamsy Montréal, Québec INTRODUCTION:
Dilatation of the aortic annulus is a cause of recurrent aortic regurgitation (AR) following aortic root reconstructive procedures. The use of an extra-aortic annuloplasty ring is a novel and potentially useful adjunct to mitigate that risk. The aim of this study was to analyze the early effectiveness and mid-term stability of this surgical technique. METHODS: From 2011 to 2015, 50 patients (mean age 4016 years) underwent adjunct extra-aortic annuloplasty ring implantation (n¼39 Dacron rings and n¼11 ExAo Coroneo rings). Median ring size was 28mm (range 27-32mm). All patients had preoperative aortic regurgitation and/or a dilated aortic annulus. The main surgical procedure was a valvesparing root remodeling procedure (n¼32) or a Ross procedure (n¼18). Preoperative, early postoperative and follow-up echocardiographic systolic and diastolic aortic annular dimensions were prospectively collected. Statistical analyses were performed using mixed effect models. Median follow-up was 2 years (100% complete). RESULTS: Use of an extra-aortic annuloplasty ring resulted in a significant decrease in both systolic (27.90.5mm preoperatively versus 23.60.3mm at discharge, p<0.001) and diastolic (24.80.4mm preoperatively versus 20.30.3mm at discharge, p<0.001) dimensions. Mid-term follow-up showed stability of the annular reduction. At 2 years, mean systolic and diastolic dimensions remained unchanged compared to their early postoperative values (24.40.3mm in systole and 22.1-.3mm in diastole, p¼NS versus at discharge). Systolic expansion of the annulus was conserved early after surgery (13,8% systolic expansion) and preserved up to 2 years after ring implantation (9,4% systolic expansion). No differences in