Endocarditis following the Ross procedure: the advantage of a living valve

Authors

  • Giuditta Coppola Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Giovanni Melina Department of Cardiac Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
  • Fabio De Robertis Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Maximiliaan Notenboom Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
  • Mohammad Yousuf Bilal Salmasi Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom & Department of Surgery, Imperial College London, London, United Kingdom
  • Paolo De Siena Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Mohamed Elshalkamy Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Shiva Seyed Mokhtassi Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Albaraa Al Holy Magdi Yacoub Institute, Heart Science Centre, Harefield Hospital, London, United Kingdom
  • Mario Petrou Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Julien Gaer Department of Cardiothoracic Surgery and Transplantation, Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • Ismail El-Hamamsy Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, USA
  • Joanna J.M. Takkenberg Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
  • Magdi Yacoub National Heart and Lung Institute, Imperial College London, London, United Kingdom & Cardiac Surgery Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt

DOI:

https://doi.org/10.21542/gcsp.2025.hvbte.46

Abstract

Background: Large observational studies have shown a rapid increase in the incidence of prosthetic valve endocarditis(PVE), due to the increasing number of patients receiving heart valve substitutes.Recently,a renewed interest has gathered around the Ross procedure(pulmonary autograft) for the treatment of aortic valve disease (AVD) in adults.Being the only available living aortic valve substitute,the pulmonary autograft is thought to be more resistant to PVE.Aim of this study was to investigate the incidence of infective endocarditis (IE) following the Ross operation.

Materials and methods: We performed a post hoc analysis of a randomized clinical trial comparing AVD surgical patients undergoing homograft root replacement or the Ross procedure.In this study, the principal focus was to analyse long-term IE incidence after the Ross procedure.

Results: From September 1,1994 to May 31,2001,a total of 108 patients (16 female, median age 38 years) received a pulmonary autograft. Aortic stenosis was present in 30 (28%),regurgitation in 49(45%) and mixed disease in 29 (27%) cases.Nine patients(8%) had active endocarditis and 45(42%) were redo operations.There was only one perioperative death(0.9%).During a median follow-up of 24.1 years (IQR, 22.6-26.1 years),there was 1 case of autograft endocarditis (0.04% per year) which was treated conservatively, and 9 cases of homograft endocarditis (0.36% per year).

Conclusions: Infective endocarditis following the Ross procedure is rarely observed in the pulmonary autograft.The incidence of homograft endocarditis is consistent with the data in the literature.These data further support the importance of a living valve substitute and encourage the development of bioengineered valves.

Published

2025-10-06

Issue

Vol. 2025 No. HVBTE (2025): Proceedings of the The 10th Heart Valve Biology and Tissue Engineering Meeting

Section

The Ross Operation

License

Copyright (c) 2025 Giuditta Coppola, Giovanni Melina, Fabio De Robertis, Maximiliaan Notenboom, Mohammad Yousuf Bilal Salmasi, Paolo De Siena, Mohamed Elshalkamy, Shiva Seyed Mokhtassi, Albaraa Al Holy, Mario Petrou, Julien Gaer, Ismail El-Hamamsy, Joanna J.M. Takkenberg, Magdi Yacoub

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This work is licensed under a Creative Commons Attribution 4.0 International License.

This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.