A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry

作者：Sievers Hans Hinrich^*; Stierle Ulrich; Charitos Efstratios I; Takkenberg Johanna J M; Hoerer Juergen; Lange Ruediger; Franke Ulrich; Albert Marc; Gorski Armin; Leyh Rainer G; Riso Arlindo; Sachweh Joerg; Moritz Anton; Hetzer Roland; Hemmer Wolfgang

来源：European Journal of Cardio-Thoracic Surgery, 2016, 49(1): 212-218.

DOI：10.1093/ejcts/ezv001

• Valve surgery
• Aortic valve
• Pulmonary autograft
• Homograft
• Ross procedure

OBJECTIVES: Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients.
METHODS: Between 1990-2013, 1779 adult patients (1339 males; 44.7 +/- 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 +/- 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years.
RESULTS: The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years.
CONCLUSION: The autograft principle results in postoperative long-term survival comparable with that of the age-and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.

• 出版日期2016-1