To define current role of the Ross operation in young patients, the outcome in those
followed longer than 20 years were assessed. Between 1994 and 2020, 81 consecutive
patients, 70 of 11 male and/or female, mean age 27 years underwent Ross procedure,
accruing 20 years of follow-up or longer. Sixty-four had bicuspid valve (79%) and
54 (67%) aortic insufficiency, while 15 (19%) had undergone prior operations. Surgery
consisted in root replacement in 53 patients, cylinder inclusion in 20 and sub-coronary
graft in 8. There were 7 late deaths in 80 hospital survivors (median follow-up 21
years, IQR 20-23), with 88% ± 5% survival at 25 years. Thirty-four patients required
left, 6 left and/or right and 1 right heart valve reoperation, on average 13 years
after Ross procedure. Reoperation was valve-sparing in 18 (45%) patients and valve
and/or root replacement in 22. Ten (24%) reoperated patients required a second reoperation
18 years after Ross procedure. Freedom from autograft reoperation was 46% ± 6%, while
from autograft valve replacement was 60% ± 7%, thanks to autograft valve-sparing.
Freedom from isolated right valve reoperation was 98% ± 4%. No mortality was associated
with any of the 51 reoperations. Root technique was associated with reoperation (P = 0.024). Age at follow-up was 50 years (IQR 36-60), with 70 (96%) patients in NYHA
class I and 6 (55%) women carrying out pregnancies. Young patients undergoing the
Ross procedure enjoy unprecedented survival well into the third decade of follow-up,
even when faced with reoperation. At 25 years risk of autograft reoperation is consistent,
while negligible for homograft. Technical improvements at operation and valve-sparing
at reoperation may prolong autograft valve durability.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AVR (aortic valve replacement), AI (aortic insufficiency), IQR (interquartile range), CABG (coronary artery bypass grafting), MACE (major adverse cardiovascular event)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 24, 2022
Footnotes
Read at the AATS 101st Annual Meeting: A Virtual Learning Experience, April 30-May 2, 2021.
Supported by Institutional Funds of the University of Verona.
Institutional Review Board approval was obtained for the conduct of this study and the board waived the need for patient consent (approval number 64927, date 30/11/2020).
Conflicts of Interest: None of the Authors has any conflict of interest.
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© 2022 Elsevier Inc. All rights reserved.
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- Commentary: The Ross Procedure is the Most Suitable Aortic Valve Operation in Young AdultsSeminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
- PreviewA living Valve Substitute in the Aortic Position has been demonstrated to improve survival and quality of life of patients requiring an aortic valve replacement operation.1 Since the inception of the Ross procedure by Donald Ross in 1967, increasing autograft reoperation rates led to its initial unpopularity. Short and Long-term outcomes of the Ross procedure in children have consistently shown to be superior to any other aortic valve replacement option, however, the same is not yet true for young adults.
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