Outcomes of Ross Procedure by Freestanding Technique vs Ross Inclusion Technique: A Single-Surgeon Experience

BACKGROUND Implementation of the Ross inclusion technique is limited. We compared outcomes after freestanding and inclusion Ross procedures in a center favoring the inclusion technique whenever feasible. METHODS Clinical and demographic data were collected for individuals who received Ross operations between September 2020 and September 2024 in a single center retrospective analysis by the institution's senior surgeon. Data of those who underwent a freestanding Ross procedure were compared to those who underwent an inclusion technique. RESULTS A total of 25 individuals met inclusion criteria; 10(40%) Ross procedures were freestanding and the remaining 15(60%) utilized the inclusion technique. The inclusion technique group, compared to those who underwent a freestanding Ross, were older (median=19.3, IQR:13.0-27.3 vs. 4.3 (3.0-17.0)), had more bicuspid valve morphology (n=12(80%) vs. 5(50%)), and had undergone previous AV interventions less frequently (27% vs. 60%). Preoperatively, the pulmonary annulus was a median of 3.5mm larger than the aortic annulus in the freestanding group and 3mm smaller than the aortic annulus in the inclusion group. In the immediate postoperative period, the inclusion technique group had one case of mild aortic insufficiency. The remaining 14 cases exhibited either none or trivial insufficiency and no stenosis; the freestanding group had no cases of mild or greater insufficiency or stenosis. There were no operative mortalities. CONCLUSIONS The Ross inclusion technique provides excellent outcomes, including in patients with bicuspid aortic valves and may be procedure of choice for adults and adolescents presenting with some degree of aortic annular dilation.