The Ross procedure was associated with a 24.4% rate of first reoperation over a mean follow-up of 16.8 years, while secondary Ross surgery showed better long-term left ventricular function.
Cohort (n=82)
Yes
What are the long-term outcomes, including mortality and reoperation rates, in adults who have undergone the Ross procedure?
The Ross procedure offers low long-term mortality in adults, though approximately one in four patients will require reintervention, most commonly on the pulmonary valve.
Introduction In aortic valve disease, several interventions are available. In young people who are still growing, or considering the risks of long-term anticoagulation, the Ross procedure remains an alternative for aortic valve replacement. This procedure entails the transposition of the patient’s pulmonary valve to the aortic position, with placement of a homograft in the pulmonary position. However, long-term prognosis remains largely unknown. Methods The Swedish national registry of congenital heart disease was searched for adult patients with a history of Ross operation. Results 82 patients (mean age 40.4±15.8 years) were identified, with a mean age at the time of the Ross procedure of 23.6±14.7 years. After a mean follow-up of 16.8±5.5 years, 24.4% of patients underwent a first reoperation involving either the neoaortic valve or the pulmonary homograft, at a mean age of 32.0±13.9 years. The cumulative incidence of reoperation was approximately 15% at 10 years and 30% at 20 years post-Ross procedure. Among the 20 reinterventions, 17 (85.0%) involved the pulmonary valve and 8 the neoaortic valve; five patients underwent procedures on both valves. Two patients (2.3%) died during follow-up. Forty-eight patients in the cohort had undergone primary Ross surgery. This subgroup was older at the time of data extraction (mean age 46.7±15.7 years) compared with those who underwent secondary Ross surgery (mean age 31.3±10.7 years), that is, typically following previous interventions. The secondary Ross group demonstrated better left ventricular function, with ejection fraction >50% in 91.7% of cases, compared with 69.8% in the primary group (p=0.041). Conclusion One in four patients undergoing the Ross procedure requires a reintervention, commonly involving the pulmonary valve. Long-term mortality was low. In selected patients, the Ross procedure remains a viable option; however, late morbidity must be considered. Our findings suggest that secondary Ross surgery is associated with better long-term outcomes, particularly regarding left ventricular function, although the underlying mechanisms remain unclear.
Mahmoud et al. (Wed,) conducted a cohort in Aortic valve disease (n=82). Ross procedure was evaluated on First reoperation involving either the neoaortic valve or the pulmonary homograft. The Ross procedure was associated with a 24.4% rate of first reoperation over a mean follow-up of 16.8 years, while secondary Ross surgery showed better long-term left ventricular function.