Ross Operation with Autologous External Autograft Stabilization - Long-term Results.

Abstract

BACKGROUND\nWe have proposed an external stabilization technique to minimize autograft dilatation after the Ross operation. The aim of this study was to analyze autograft function and root dimensions following root replacement with and without external root support.\n\n\nMETHODS\nBetween 10/1995 and 02/2021, 185 adult patients (73% male; age 38±9 years) underwent a Ross operation as full-root replacement with (n=136) or without support (n=49). Autograft function and root dimensions were determined echocardiographically. Median follow-up was 3.4[1.13-14.74] years; it was 95% complete. Survival and freedom from reoperation were calculated; changes in autograft root dimensions were analyzed using mixed-effect models.\n\n\nRESULTS\nSurvival (95%) and freedom from autograft reoperation (94%) at 15 years were higher with than without support (p=0.003 or p=0.004). In the first five years, patients with support showed an indexed root size progression of 0.712mm/(year*m)(p=0.003) compared to 1.554mm/(year*m)(p=0.001) without. Progression rates were higher for patients without stabilization (p=0.045). After five years, progression rates were similar in both groups (0.248mm/(year*m)(p<0.001) with persistent difference between the groups.\n\n\nCONCLUSIONS\nThe Ross procedure as full-root replacement is associated with a relevant rate of autograft dilatation and reoperation. The use of external root stabilization may reduce autograft dilatation and is associated with improved survival and durability.