Critical analysis of the Ross procedure: do its problems justify wider application?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery

Background:

• The Ross procedure demonstrates superior hemodynamic function in younger patients with aortic root pathology.
• Technical complexity and potential complications currently limit the broader application of the Ross procedure.

Purpose of the Study:

• To summarize the mortality and morbidity associated with the Ross procedure using the root replacement implantation technique.
• To evaluate the safety and efficacy of the Ross procedure in a consecutive patient series.

Main Methods:

• A retrospective review of 130 consecutive patients who underwent the Ross procedure between October 1990 and October 1998.
• Analysis of pre- and post-operative New York Heart Association (NYHA) classifications, aortic insufficiency (AI) severity, and procedural outcomes.
• Detailed reporting of operative times, patient follow-up duration, mortality rates, and specific morbid events.

Main Results:

• Mean patient age was 36 years, with congenital conditions being the most common diagnosis (80.7%).
• Postoperative follow-up showed 94.4% of patients in NYHA class I and 93.6% with minimal (0-1+) postoperative AI.
• The 30-day mortality rate was 1.5%, with no late mortality observed. Morbidity included rare instances of autograft explant and reoperation.

Conclusions:

• The Ross procedure, when performed with the root replacement implantation technique, exhibits low postoperative morbidity and mortality.
• These findings support the consideration of broader application of the Ross procedure in suitable patient populations.
• The study highlights the long-term benefits and safety profile of the Ross procedure for aortic root pathology.