Autograft Failure During Follow-Up After the Ross Procedure: Predictive Factors in a Prospective Series

To determine the incidence of, and predictive factors for, aortic autograft failure during follow-up after the Ross procedure. Of 102 consecutive patients who underwent surgery at our centre between 1997 and 2009, we selected 83 (age 32±11 years), all of whom had been discharged without significant autograft regurgitation and for whom at least one follow-up echocardiogram was available. Autograft failure was defined as the presence of at least moderate regurgitation on echocardiography. After a median follow-up period of 4.2 years (range 0.2–10.9 years), eight patients (9.6%) developed this complication, three of whom required valve replacement. The probability of survival without autograft failure at 5 years was 90% (95% confidence interval [CI] 83%–98%). Multivariate analysis showed that undergoing surgery during the first 6 months of the learning curve (hazard ratio = 9.1; 95% CI, 1.4–59.4; P=.021) and a large pulmonary annulus size, normalized by body surface area, (hazard ratio = 1.4; 95% CI, 1.016–1.924; P=.04) were independent predictors of this complication.

Para analizar la incidencia y los factores predictores de la insuficiencia del autoinjerto aórtico durante el seguimiento tras la intervención de Ross, de 102 pacientes operados consecutivamente en nuestro centro entre 1997 y 2009, se seleccionó a 83 (media de edad, 32 ± 11 años) sin regurgitación significativa del autoinjerto al alta y con al menos un ecocardiograma de seguimiento. La insuficiencia del autoinjerto se definió como aquella al menos moderada por ecocardiografía. Tras una mediana (intervalo) de 4,2 (0,2–10,9) años de seguimiento, 8 (9,6%) pacientes presentaron esta complicación (3 precisaron sustitución valvular). La probabilidad de supervivencia libre de insuficiencia del autoinjerto fue del 90% (intervalo de confianza [IC] del 95%, 83%–98%) a los 5 años. En el análisis multivariable, la intervención en los primeros 6 meses de la curva de aprendizaje (hazard ratio [HR] = 9,1; IC del 95%, 1,4–59,4; p = 0,021) y el mayor tamaño del anillo pulmonar (normalizado para la superficie corporal, HR = 1,4; IC del 95%, 1,016–1,924; p = 0,04) fueron predictores independientes de esta complicación.