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DOI: 10.1055/s-0029-1246992
Major adverse cardiac events after the Ross operation in 1620 patients – current status of the German-Dutch Ross Registry with up to 20 years follow-up
Background: Reports on autograft and allograft durability as well as major adverse cardiac events (MACE) over time after the Ross procedure and in large patient cohorts are scarce in the literature. Aim of this study to report the MACE observed in the large patient population of the German-Dutch Ross Registry.
Methods: 1620 patients (mean age 39.2±16.1, range 0.0–70.5y, male=1211) underwent a Ross procedure with a mean follow-up of 5.4±3.9y (10747 pt*years, range: 0.1–20.39y). MACE data were evaluated and reported in accordance to the 2008 guidelines.
Results: Follow-up completeness was 94.6%. All cause mortality was n=72 (4.4%, cardiac=49, 3.0%). Overall survival was 96.8% at 5y and 94.6% at 10y. Structural and non-structural autograft failure with the need of reoperation occurred in n=94 (5.8%), resulting in a freedom from autograft reoperation of 97.1% at 5y and 93.0% at 10y (mean time to reoperation 6.7±5.0y). Allograft failure with the need of reoperation occurred in n=63 (3.9%) with a freedom from allograft reoperation of 96.9% at 5y and 93.7% at 10y (mean time to reoperation 4.4±4.4y). 10 valvuloplasties were included in these numbers. Freedom from autograft and allograft reoperation was 94.5% at 5y and 88.1% at 10y. Infective endocarditis (conservative or medically treated) occurred in n=43 (linearized occurrence rate, LOR: 0.40%/patient-year), thrombotic and thromboembolic events (including TIA) in n=47 (LOR: 0.44%/patient-year).
Conclusion: A low rate of MACE in the long term after the Ross operation was observed in the registry. Caution ought to be attended to allograft and autograft endocarditis.