25 años de cirugía de Ross: seguimiento y resultados en pacientes reoperados en nuestro centro

Abstract

Background

Ross surgery is a relatively infrequent procedure due to its technical complexity and its long-term outcomes not being exempt from controversy. We analyzed the outcomes of our series of patients undergoing the Ross procedure and those who required reintervention due to dysfunction of the pulmonary autograft or homograft.

Methods

Since 1998, 108 patients underwent Ross surgery at our center, with root replacement (RR) surgical technique used in 105 of them. We retrospectively reviewed data from a subgroup of patients who underwent reintervention after Ross surgery due to dysfunction of the autograft or homograft. Their characteristics and survival were studied using Kaplan-Meier analysis.

Results

The mean follow-up of the patients undergoing RR was 17.5 ± 5 years (median 19 years, range 0-25 years). During this period, 29 patients (26.9%) required at least one reintervention: 13 patients (44.8%) due to autograft dysfunction, 7 patients (24.1%) due to homograft dysfunction, and 9 patients (31%) due to dysfunction of both autograft and homograft. The mean time to reintervention due to autograft dysfunction was 11.8 ± 5.2 years (median 12 years, range 2-19 years) and due to homograft dysfunction was 12.6 ± 5 years (median 13 years, range 2-19 years). Hospital mortality was null. The follow-up of these reintervened patients was 18.7 ± 3.1 years (median 19 years, range 9-23), and the mortality during this period was 10% (n = 3): two due to cardiac causes and one due to non-cardiac causes. The cumulative survival function of patients who underwent reintervention at 10 years was 100%, and at 20 years it was 93%.

Conclusions

The Ross procedure is associated with a non-negligible risk of reoperation. In our series of patients, no early mortality has been observed following reoperation due to dysfunction of the pulmonary autograft or homograft.