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Ross operation: 16-year experience

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1 Ross operation: 16-year experience
Ronald C. Elkins, MD, David M. Thompson, PhD, Mary M. Lane, PhD, C. Craig Elkins, MD, Marvin D. Peyton, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 136, Issue 3, Pages e5 (September 2008) DOI: /j.jtcvs Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Survival (all causes) among the 487 patients compared with survival of the US population matched for each patient's age, sex, and year of operation. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Predicted freedom from autograft failure by sex and for primary lesion for the proportional hazard model. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Observed and predicted probabilities of autograft valve insufficiency over time. Predicted percentages of aortic insufficiency (AI) grade (solid line) are obtained from an ordinal longitudinal (generalized estimating equation) model and sum to 100% at a given time of follow-up. The predicted percentage of patients with no AI (grade 0) decreases, whereas other grades gradually increase in time. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Predicted probabilities of 3+ (moderate–severe) or 4+ (severe) autograft valve insufficiency (AGI) by means of generalized estimating equations over time. AGI slowly increases from 3.3% (70% confidence interval, 2.7%–4%) at 5 years to 21.5% (confidence interval, 15.3%–29.4%) at 16 years. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

6 A, Aortic valve replacements in adults, Ross operations, and all others at University of Oklahoma Health Sciences Center, August 1986 through June B, Aortic valve replacements in children, Ross operations in children, and all others at University of Oklahoma Health Sciences Center, August 1986 through June 2002. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

7 Actuarial survival from all causes and from valve-related deaths in 487 patients having a Ross operation, August 1986 through June 2002 as of August 2004. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

8 The z-transformed autograft sinus or root diameter of all 2147 echocardiograms obtained in 383 operative survivors over time. All calculated z scores are displayed (+) for each individual patient and connected by a line ending with the last follow-up. Significant variation occurred with the z scores of each individual patients over time related to variation in echocardiographic diameters measured and in some caused by increases in body surface area. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

9 Mean observed and predicted z-transformed autograft sinus or root diameters. Observed mean diameters are calculated from individual patient means so that, for example, the mean at time zero represents all echocardiograms performed up to the third month. Means displayed for 0.5, 1, and 1.5 years include echocardiograms performed within 3 months of these time points. The mean reported at 2 years aggregates information from echocardiograms performed between 21 and 30 months after the operation. Means reported for 3 to 10 years of follow-up use all echocardiograms performed within 6 months. The mean reported for 12 years use all studies reported within 12 months. The small numbers available after 12 years of follow-up are shown individually. The predicted mean scores are derived from the general linear mixed model. The observed baseline (time = 0) mean z value of 1.97 ± 1.88 increases to a z value of 3.15 ± 2.18 at 1 year after the operation. Change thereafter is gradual. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

10 A, Individual plots over time of the calculated ratio of measured autograft diameter/predicted aortic diameter (by body surface area) for each patient (86) with a ratio of 1.5 or more. Consistent progressive increase in diameter was rarely identified. B, Individual plots over time of the calculated ratio of measured autograft diameter/predicted aortic diameter (body surface area) for each patient (45) with a ratio of 1.5 or greater on more than 1 echocardiogram. Some of these patients have shown a consistent increase in the value of their ratio and might be candidates for elective surgical intervention. The Journal of Thoracic and Cardiovascular Surgery  , e5DOI: ( /j.jtcvs ) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

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