Aortic insufficiency following balloon aortic valvuloplasty does not impact long-term autograft durability after the Ross procedure

Abstract

Objective

Preoperative aortic insufficiency (AI) is associated with inferior autograft durability after the Ross procedure. However, many patients with aortic stenosis (AS) undergo balloon aortic valvuloplasty (BAV) early and present with longstanding AI before Ross. We studied how BAV and subsequent valvular pathology impacts autograft durability.

Methods

Patients undergoing the Ross operation from 1993-2020 were identified. Those who underwent BAV prior to Ross were compared to patients who did not undergo BAV and underwent Ross for predominant AI (AI group) or AS (AS group). Those who underwent previous open surgical AV intervention were excluded. Primary outcome of interest was autograft failure, defined as a composite of autograft reintervention or severe insufficiency.

Results

A total of 198 patients were included. Seventy-nine (39.9%) underwent BAV and subsequently underwent the Ross for predominant AI (45.6%) or AS (54.4%). Of patients who did not undergo BAV, 66 (33.3%) presented with predominant AI and 53 (26.8%) with AS. Freedom from autograft failure at 15 years was 90%, 92%, and 62% in BAV, AS, and AI groups, respectively. The AI group was at significantly increased risk of long-term autograft failure (HR 5.6, p=0.01), while AS and BAV groups had similar, low risk (HR 1.1, p=0.91). Autograft durability was similar among BAV patients who presented with AS or AI before the Ross (p=0.84).

Conclusion

BAV prior to the Ross procedure is common in patients with AS. These patients have excellent long-term autograft durability regardless of preoperative valvular pathology and should strongly be considered for the Ross operation.