Utilization and Short-Term Outcomes of the Ross Procedure in Older Adults Compared With Prosthetic Aortic Valve Replacement

INTRODUCTION The Ross procedure is preferentially performed in younger adults because of favorable hemodynamics, valve durability, and avoidance of long-term anticoagulation. We evaluated national utilization patterns and inpatient outcomes of the Ross procedure in older adults compared with younger Ross patients and older adults undergoing prosthetic aortic valve replacement (AVR). METHODS A retrospective analysis of the National Inpatient Sample (2016-2021) identified 155 adults undergoing isolated RP. Patients were stratified into <50 y (younger group, YG) and ≥50 y (older group, OG). In addition, 8383 OG patients undergoing isolated prosthetic AVR were included. Demographics, clinical characteristics, and operative outcomes were compared using standard statistical methods. RESULTS 82% were in YG and 18% in the OG, with median ages of 29 and 54.5 y, respectively. No patients >70-y of age received the RP. Ross procedure utilization among older adults increased during the study period, although its use remained rare compared with prosthetic AVR and demonstrated regional and socioeconomic variation. RP as redo AVR was performed only in YG. Congenital aortic valve disease was the most common indication in both groups. Comorbidities were higher in the OG, with a higher postoperative morbidity but no mortality difference. Short-term inpatient outcomes between Ross and prosthetic AVR in older adults were comparable. Ross procedures for endocarditis were uncommon and associated with higher rates of neurologic complications. CONCLUSIONS RP use in older adults is increasing but remains limited. Despite greater comorbidity burden, older adults undergoing the Ross procedure demonstrated comparable in-hospital mortality and short-term inpatient outcomes relative to younger Ross patients and older adults undergoing prosthetic AVR. Endocarditis cases demonstrated less favorable outcomes.