Comparison of the Ross Procedure in Patients with Endocarditis and Noninfective Valve Disease: Long-term Follow-up of 641 Patients

 

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Objectives: Executed by an experienced surgeon, the Ross procedure is an excellent alternative to prosthetic aortic valve replacement in young patients and might be advantageous in the setting of infective endocarditis (IE), since no prosthetic material is implanted thus keeping the use of foreign material to a minimum. The aim of this study was to compare early and long-term outcome after the Ross procedure in patients with IE and non-infective aortic valve disease.

Methods: 641 patients underwent the subcoronary Ross procedure at our institution. All patients had prospective clinical and echocardiographic examinations annually. IE was present in 151 patients (30 with active and 121 with past IE). Mean follow-up was 11.8 ± 5.1 years with a range of 0–22.3 years and a total cumulative follow-up of 7404 patient years. Follow-up completeness was 99.4%.

Results: In patients with noninfective aortic valve disease, survival rates after 5, 10, 15 and 20 years were 97.8, 96, 87.4, and 76.7%, respectively. In patients with active IE, survival rates after 5, 10, 15, and 20 years were 92.3, 92.3, 87.9, and 54.9%, respectively. In patients with past IE, survival rates after 5, 10, 15, and 20 years were 97.5, 91.5, 82.7, and 69.5%, respectively. Statistical analysis revealed no significant difference between patients with IE and non-infective valve disease (p = 0.534). Rates of freedom from reoperation in patients with noninfective aortic valve disease after 5, 10, 15, and 20 years were 97, 93.6, 90.7, and 86.6%, respectively. In patients with active IE, rates of freedom from reoperation after 5, 10, 15, and 20 years were 100, 91.7, 85.6, and 64.2%, respectively. In patients with past IE, rates of freedom from reoperation after 5, 10, 15, and 20 years were 98.3, 94.7, 91.3, and 89.8%, respectively. There was no significant difference between patients with IE and non-infective aortic valve disease (p = 0.549). Autograft or homograft IE occurred in 30 patients, 21 of these had previous non-infective valve disease, 2 active IE and 7 past IE. There was no significant difference between patients with infective and non-infective valve disease (p = 0.61). 15 of these patients needed re-operation and 15 were initially treated conservatively although 4 of them needed re-operation over time.

Conclusion: The Ross procedure is a safe and feasible treatment in the setting of IE with a low recurrence rate of IE being comparable to that of patients with previous non-infective aortic valve disease.