CONGENITAL – Original Submission| Volume 35, ISSUE 1, P115-124, March 2023

Long-term Outcomes of the Ross Procedure for Young Patients with Aortic Valve Disease

      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



      AVR (aortic valve replacement), AI (aortic insufficiency), IQR (interquartile range), CABG (coronary artery bypass grafting), MACE (major adverse cardiovascular event)
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      Linked Article

      • Commentary: The Ross Procedure is the Most Suitable Aortic Valve Operation in Young Adults
        Seminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
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          A 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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