May 2, 2026Journal of the American College of Cardiology103 citations
View Full PaperClinical Outcomes Following the Ross Procedure in Adults
Structured PICO
What are the very-long-term survival and reintervention rates following the Ross procedure in adults compared to the general population?
P
Population
310 adults (mean age 40.8 years) undergoing the Ross procedure at a single institution, including 227 (73.2%) with bicuspid aortic valve and 225 (72.6%) with aortic stenosis.
I
Intervention
Ross procedure
C
Comparator
Age- and sex-matched subjects from the general population (for survival analysis)
O
Outcome
Very-long-term survival and freedom from Ross-related reinterventionhard clinical
The Ross procedure in adults provides excellent long-term freedom from reintervention, but long-term survival remains significantly lower than that of the age- and sex-matched general population.
Abstract
BACKGROUND: Very few reports of long-term outcomes of patients who underwent the Ross procedure have been published. OBJECTIVES: The authors reviewed their 25-year experience with the Ross procedure with the aim of defining very-long-term survival and factors associated with Ross-related failure. METHODS: Between January 1990 and December 2014, the Ross procedure was performed in 310 adults (mean age 40.8 years) at a single institution. All patients were prospectively added to a dedicated cardiac surgery registry. Complete post-operative clinical examination and history were obtained, and transthoracic echocardiography was performed according to a standardized protocol. There was no loss to follow-up. Median follow-up was 15.1 years and up to 25 years. RESULTS: Bicuspid aortic valve was diagnosed in 227 patients (73.2%), and the most common indication for surgery was aortic stenosis (n = 225 72.6%). Freedom from any Ross-related reintervention was 92.9% and 70.1% at 10 and 20 years, respectively. Independent risk factors for pulmonary autograft degeneration were pre-operative large aortic annulus (hazard ratio: 1.1; p = 0.01), pre-operative aortic insufficiency (hazard ratio: 2.7; p = 0.002), and concomitant replacement of the ascending aorta (hazard ratio: 7.7; p = 0.0003). There were 4 hospital deaths (1.3%), and overall survival at 10 and 20 years was 94.1% and 83.6%, respectively. Long-term survival was not significantly different in patients who required Ross-related reintervention (log-rank p = 0.70). However, compared with the general population, survival was significantly lower in patients following the Ross procedure when matched on age and sex (p < 0.0001). CONCLUSIONS: The Ross procedure was associated with excellent long-term valvular outcomes and survival, regardless of the need for reintervention. Adults presenting with aortic insufficiency or a dilated aortic annulus or ascending aorta were at greater risk for reintervention. Unlike previous reports, long-term survival was lower in Ross patients compared with matched subjects.