The feasibility of the introduction of the Ross program in adults: early safety and quality outcomes in a single center

Background The optimal valve substitute for young and middle-aged patients with severe symptomatic aortic valve disease remains a subject of debate. In this patient group, prosthetic valves are associated with reduced survival, impaired hemodynamics, and lifelong risk of valve-related complications. The Ross procedure has re-emerged as the most optimal valve substitute following surgical refinements and improved perioperative care. The current study describes the feasibility in terms of safety and early outcomes of a newly initiated Ross program using the patient-tailored total root technique. Methods All patients who underwent the Ross procedure at the Radboud University Medical Center between April 2024 and December 2025 were included. Baseline characteristics, operative details, and postoperative outcomes were extracted from the electronic medical record. Results A total of 32 patients were included, with a median age of 39 years; 65% were male, and 94% had a bicuspid aortic valve. The predominant pathology was pure stenosis in 63%. All procedures were elective except one. There was no operative or 30-day mortality. Complications included one conversion to a Bentall procedure for leaflet retraction and one urgent percutaneous coronary intervention, probably due to right coronary button kinking. No patient had more than mild aortic regurgitation at discharge. Conclusions The Ross procedure in young and middle-aged adults was associated with favorable short-term outcomes in this initial cohort. These results support the feasibility and safety of the Ross procedure when performed in a dedicated expert center. Ongoing follow-up will be essential to assess medium- and long-term durability.