Long-Term Clinical Outcomes and Health-Related Quality of Life After the Ross Procedure

BACKGROUND: This study sought to evaluate long-term clinical outcomes and health-related quality of life (HR-QoL) in young adults after Ross procedures for aortic valve disease. METHODS: From January 1990 to April 2021, 166 patients aged 14 to 63 years underwent the Ross procedure at Cleveland Clinic (Cleveland, OH). Outcomes included postoperative events, longitudinal autograft valve function, reinterventions, and survival. HR-QoL was assessed cross-sectionally using validated instruments, including the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10) and MacNew. Associations between patient variables, including area deprivation indices (a socioeconomic metric), and HR-QoL measures were analyzed using random forest regression. RESULTS: Median follow-up of 6 years showed stable postoperative autograft valve function. Reintervention was needed in 20 patients, with a 10-year freedom from reintervention of 89%. Increased economic hardship or inequality and lower education were associated with higher cardiac reintervention risk. The 25-year survival was 70%, with no deaths for operations performed after 2000. Significantly better mental HR-QoL PROMIS-10 scores were obtained compared with the general population norm (median [15th, 85th percentile]: 53 [43, 64] vs 50; P = .001), whereas physical HR-QoL scores showed no significant difference (48 [42, 55] vs 50; P = .2). All domains of the MacNew were significantly better compared with matched patients with heart disease (P < .0001). State-referenced area deprivation indices were not associated with HR-QoL PROMIS-10 or MacNew scores. CONCLUSIONS: The Ross procedure results in favorable long-term outcomes, including survival, autograft function, and enhanced HR-QoL, in young adults with aortic valve disease. Despite low mortality and stable valve function, reinterventions, especially among socioeconomically disadvantaged patients, pose concerns.