Long-term outcomes with the pulmonary autograft inclusion technique in adults with bicuspid aortic valves undergoing the Ross procedure.
Publication Year:
2023
PubMed ID:
33685733
Funding Grants:
Public Summary:
The Ross procedure is a heart surgery used to replace a diseased aortic valve, sometimes using a patient’s own pulmonary valve. In adults with bicuspid aortic valves, surgeons can either “wrap” the transplanted valve to reinforce it or leave it unwrapped. This study followed 129 patients for over 10 years and compared the two approaches. Both groups had similar short-term outcomes, but patients with the wrapped valve were much less likely to experience valve failure or need another surgery. After 10 years, about 27% of unwrapped valves required reoperation, compared with only 4% of wrapped valves. These results suggest that wrapping the pulmonary valve during the Ross procedure stabilizes the aortic root and provides excellent long-term outcomes for adults with bicuspid valves.
Scientific Abstract:
OBJECTIVE: To compare outcomes with wrapped (pulmonary autograft inclusion) versus unwrapped techniques in adults with bicuspid aortic valves undergoing the Ross procedure. METHODS: Between 1992 and 2019, 129 adults with bicuspid aortic valves (aged >/=18 years) underwent the Ross procedure by a single surgeon. Patients were divided into those without autograft inclusion (unwrapped, n = 71) and those with autograft inclusion (wrapped, n = 58). Median follow-up was 10.3 years (interquartile range, 3.0-16.8 years). Need for autograft reintervention was analyzed using competing risks. RESULTS: Pre- and intraoperative characteristics as well as 30-day morbidity or mortality did not differ between cohorts. Survival at 1, 5, and 10 years, respectively, was 97.2%, 97.2%, and 95.6% in the unwrapped cohort and 100%, 100%, and 100% in the wrapped cohort (P = .15). Autograft valve failure occurred in 25 (35.2%) of the unwrapped and 3 (5.2%) of the wrapped patients. Competing risks analysis demonstrated the wrapped cohort to have a lower need for autograft reintervention (subhazard ratio, 0.28, 95% confidence interval, 0.08-0.91; P = .035). The cumulative incidence of autograft reintervention (death as a competing outcome) at 1, 5, and 10 years, respectively, was 10.2%, 14.9%, and 26.8% in the unwrapped cohort and 4.0%, 4.0%, and 4.0% in the wrapped cohort. CONCLUSIONS: In adults with bicuspid aortic valves, the Ross procedure with pulmonary autograft inclusion stabilizes the aortic root preventing dilatation and reduces the need for reoperation. The autograft inclusion technique allows the Ross procedure to be performed in this population with excellent long-term outcomes.
