Congenital Heart Surgeons' Society

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Mid-term And Long-term Outcomes Following Reinforced Ross Operation
Awais Ashfaq, MD, Hayden Leeds, Irving Shen, MD, Ashok Muralidaran, MD.
Oregon Health Sciences University, Portland, OR, USA.

Objective(s): The Reinforced Ross procedure was first described at our institution in 2004 to address the concerns of progressive autograft dilation and neo-aortic insufficiency following the traditional Ross operation. We aim to describe our experience and long-term outcomes.
Methods: All patients who underwent the Reinforced Ross procedure at our institution from 2004 to 2019 were included. Relevant demographics and clinical variables were reviewed.
Results: Of 24 identified patients, 20 were male (83.3%). Median age at surgery was 27 years (Range: 12-58). Twenty-two patients (91.7%) had a bicuspid aortic valve. Indications for surgery included aortic stenosis (AS, n=5), aortic insufficiency (AI, n=7) and mixed disease (n=12). Six patients had preoperative ascending aortic dilation requiring simultaneous ascending aortic replacement. No patient had more than mild AS or AI on postoperative transesophageal echocardiogram. Five patients (20.8%) underwent subsequent aortic valve replacement and 1 (4.2%) had aortic valve repair. Median time to re-intervention was 2 years. All aortic re-interventions were performed from patients early in our experience (2004-2007). No patient had more than moderate AS or AI on last echocardiogram. One patient had mild aortic root dilation (4.1cm) on last follow-up, and there was no ascending aortic dilation (>4.5cm). Median follow up was 6.5 years. Fourteen patients had 5 years or more of follow-up. All patients were alive at time of last follow up.
Conclusions: The Reinforced Ross is a safe and durable option for older children and adults requiring aortic valve replacement. We experienced an institutional learning curve during the initial years.