Ross Procedure for Aortic Regurgitation versus Stenosis in Adults With and Without Autograft Support

OBJECTIVES: The Ross procedure for aortic regurgitation (AR) and abnormal aortic valve morphologies is associated with an increased risk of autograft dilatation. Autograft support may ameliorate this problem. We analysed the results for all haemodynamic lesions and the effect of autograft support. METHODS: A retrospective analysis was conducted of patients who underwent a Ross procedure at Saarland University Medical Center between December 1995 and December 2023. Three hundred and fifteen patients underwent full-root replacement with or without autograft support. Twenty-three (7%) were younger than 18 years and were excluded. The cohort was divided into 3 groups: patients with aortic stenosis (AS), AR and combined disease (CD). End points included survival, freedom from reoperation and AR and aortic root dimensions; these were compared among the 3 groups. Median follow-up was 3.6 (range 0.01-26.6) years and 95% complete. RESULTS: Overall, 292 adult patients [male 74%; mean age 39 years (SD: 10)] were analysed with (n = 209) or without autograft support (n = 83). Patients with AS (n = 79; 28%) were compared to those with AR (n = 77; 25%) and those with CD (n = 136; 50%). Valve morphology was unicuspid (n = 141; 48%), bicuspid (n = 109; 38%) or tricuspid (n = 42; 14%). Survival at 15 years was similar across the groups (AR 86%; AS 93%; CD 94%; P = 0.123). Freedom from autograft reoperation was 90% at 10 years (AR 80%; AS 95%; CD 92%; P = 0.009). With autograft support, it was 93% at 10 years (AR 90%; AS 93%; CD 95%; P = 0.179). Neither a unicuspid (hazard ratio 1.072; 95% confidence interval 0.34-3.43; P = 0.907) nor a bicuspid aortic valve (hazard ratio 0.102; 95% confidence interval 0.08-1.26; P = 0.102) was associated with reoperation. CONCLUSIONS: Patients with AR and an unsupported root replacement do have an increased risk of reintervention, irrespective of aortic valve morphology. With autograft support, however, autograft stability is excellent, irrespective of the underlying lesion. Thus, the Ross procedure in its supported version can be offered to all haemodynamic types and valve morphologies. CLINICAL REGISTRATION: CEP 203/19.