Key result
Autograft rupture or dissection after Ross procedure develops at ~10 years, primarily in BAV patients.
Why the study?
The Ross procedure provides physiologic hemodynamics without anticoagulation for young patients needing aortic valve replacement, but rare catastrophic complications like autograft dissection and rupture can occur years later.
Systematic Review (n=11)
Yes
Autograft dissection or rupture after the Ross procedure is a rare but life-threatening complication that can occur at diameters below conventional thresholds (≤55 mm), necessitating vigilant lifelong surveillance.
Answers are grounded in this paper and cite their sources.
Warrants lifelong surveillance after Ross even at ≤55 mm; challenges conventional autograft diameter thresholds.
The Ross procedure offers physiologic hemodynamics and freedom from anticoagulation for young patients needing aortic valve replacement, yet rare catastrophic complications such as autograft (neoaortic) dissection and rupture can occur years later. PRISMA-guided search (inception–August 2025) identified peer-reviewed reports with patient-level data on presentation, imaging, management, and outcomes. Eleven cases were included. Median age was 39 years (range 20–56) and 55% were male. Median interval from Ross to event was 10 years (range 6–18). Native bicuspid aortic valve (BAV) morphology was documented in 9 out of 11. Median autograft root diameter was 55 mm (range 50–90), with 60% occurring at ≤ 55 mm. Presentations were symptomatic in 7/11, incidental in 3/11, and fatal preoperative rupture in 1/11. Echocardiography was the most common initial test; diagnosis was confirmed by CT (6/11) or MRI (3/11). Disease was confined to the autograft root in 9/11. Ten patients underwent operative intervention with 100% survival to discharge (composite root replacement 6/10; valve-sparing or root remodeling 4/10). Autograft dissection or rupture after Ross is rare but life-threatening, concentrated among patients with native BAV, and can occur below conventional diameter thresholds. Vigilant lifelong surveillance and consideration of earlier elective intervention are warranted.
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Ramkaran et al. (2026) conducted a systematic review in Aortic autograft dissection and rupture after Ross procedure (n=11). Ross procedure was evaluated on Incidence of autograft rupture or dissection. Autograft rupture or dissection after the Ross procedure was reported in 11 cases with a median interval of 10 years from surgery to event occurrence, primarily affecting patients with bicuspid aortic valve morphology.
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