A Framework for the Evaluation and Reporting of Outcomes after Complex Heart Valve Interventions: Applications to the European Ross Registry

Abstract

Chapter 1 is the general introduction of the thesis. Chapter 2 presents a proposal on the nomenclature of the aortic root components. Chapters 3 and 4 present the single center results with the subcoronary Ross procedure in the University of Lübeck. Chapter 5 describes the durability of the autograft and homograft as observed in the large population of the German-Dutch Ross registry. Modes of autograft and homograft failure are presented as well as detailed outcomes of the observed reoperations. Chapter 6 challenges a popular belief that the Ross procedure in the presence of a bicuspid aortic valve is associated with reduced durability. Chapter 7 discusses the problem of competing risks when evaluating conduit durability. Chapter 8 presents the results of an effort to improve autograft durability after the Ross procedure. Chapter 9 presents clinical outcomes after the Ross procedure and provides a basis for the further judgment of this procedure and assist physician–patient discussion about the risks, benefits, and expectations after the Ross procedure.Chapter 10 presents a comparison of the survival of Ross patients with the survival of patient with mechanical valves after optimal and intensive anticoagulation monitoring. Chapters 11 and 12 focus on specific aspects of homograft durability. Chapter 13 discusses the results and the knowledge obtained from the above mentioned studies and research questions are summarized and put in perspective. Pitfalls in the methodologies used to evaluate outcomes after the Ross procedure are presented with examples from the European Ross Registry and discussed, which are generalizable in the evaluation of outcomes after complex heart interventions.