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Long-Term Outcomes and Modes of Failure of the Ross Operation in Patients with Aortic Insufficiency

Long-Term Outcomes and Modes of Failure of the Ross Operation in Patients with Aortic Insufficiency. Joel Price MD, MPH, Laurent De Kerchove MD, David Glineur MD, PhD, Jean Rubay MD, and Gebrine El Khoury MD Department of Cardiovascular and Thoracic Surgery Cliniques St. Luc

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Long-Term Outcomes and Modes of Failure of the Ross Operation in Patients with Aortic Insufficiency

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  1. Long-Term Outcomes and Modes of Failure of the Ross Operation in Patients with Aortic Insufficiency Joel Price MD, MPH, Laurent De Kerchove MD, David Glineur MD, PhD, Jean Rubay MD, and Gebrine El Khoury MD Department of Cardiovascular and Thoracic Surgery Cliniques St. Luc Brussels, Belgium

  2. Background • Long-term durability of the Ross operation when performed for isolated aortic insufficiency has been questioned. • Especially important in the setting of a regurgitant bicuspid aortic valve • bicuspid aortopathy involves the pulmonary trunk

  3. Methods • Isolated AI: AI (≥ 3+), absence of significant stenosis (mean gradient <30mmHg, AVA >1.5cm2) • Review of institutional database revealed 68 patients underwent Ross operation for AI • Mean follow-up 11.2 y, max follow-up 18.8y • Complete as of March 2011 • Statistical Anlysis: Kaplan-Meier, Log-rank and time-to-event

  4. Outcomes • Long-term survival and Cardiac survial • Recurrent significant AI (autograft regurgitation) • Reoperation • Valve-related events: • Endocarditis, hemorrhage, thrombo-embolism • Sub group analysis: • Bicuspid vs tricuspid

  5. Patient Charactersitics

  6. Long-Term Outcomes

  7. Reoperations AVSRR = Aortic Valve Sparring Root Replacement, AV = Aortic Valve, AVR = Aortic Valve Replacement

  8. Survival: Bicuspid vs Tricuspid

  9. Recurrent AI: Bicuspid vs Tricuspid

  10. Reoperation: Bicuspid vs Tricuspid

  11. VRE: Bicuspid vs Tricuspid

  12. Conclusions • Ross operation for isolated AI was associated with excellent survival and freedom from recurrent AI, reoperation and valve-related events • Bicuspid and tricuspid valves have equivalent outcomes • Main mechanisms of failure are AI and autograft dilation

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