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J Thorac Cardiovasc Surg 2008;136:623-630
© 2008 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
Department of Surgery, Section of Thoracic and Cardiovascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
Received for publication April 18, 2005; revisions received October 29, 2007; accepted for publication February 25, 2008. * Address for reprints: Ronald C. Elkins, MD, Section of Thoracic Surgery, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190. (Email: ronald-elkins{at}ouhsc.edu).
Objective: We performed a review of a consecutive series of 487 patients undergoing the Ross operation to identify surgical techniques and clinical parameters that affect outcome.
Methods: We performed a prospective review of consecutive patients from August 1986 through June 2002 and follow-up through August 2004. Patient age was 2 days to 62 years (median, 24 years), and 197 patients were less than 18 years of age. The Ross operation was performed as a scalloped subcoronary implant in 26 patients, an inclusion cylinder in 54 patients, root replacement in 392 patients, and root–Konno procedure in 15 patients. Clinical follow-up in 96% and echocardiographic evaluation in 77% were performed within 2 years of closure.
Results: Actuarial survival was 82% ± 6% at 16 years, and hospital mortality was 3.9%. Freedom from autograft failure (autograft reoperation and valve-related death) was 74% ± 5%. Male sex and primary diagnosis of aortic insufficiency (no prior aortic stenosis) were significantly associated with autograft failure by means of multivariate analysis. Freedom from autograft valve replacement was 80% ± 5%. Freedom from endocarditis was 95% ± 2%. One late thromboembolic episode occurred. Freedom from allograft reoperation or reintervention was 82% ± 4%. Freedom from all valve-related events was 63% ± 6%. In children survival was 84% ± 8%, and freedom from autograft valve failure was 83% ± 6%.
Conclusions: The Ross operation provides excellent survival in adults and children willing to accept a risk of reoperation. Male sex and a primary diagnosis of aortic insufficiency had a negative effect on late results.
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