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Updated: May 7, 2026

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Rethinking the ross procedure in adults.

T Brett Reece1, Karl F Welke2, Sean O'Brien3

  • 1Department of Surgery, University of Colorado, Denver, Colorado.

The Annals of Thoracic Surgery
|September 28, 2013
PubMed
Summary

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The Ross procedure has higher perioperative risks, including reexploration, renal failure, and operative mortality, compared to conventional aortic valve replacement. These risks have led to a significant decline in its use.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Valve Replacement

Background:

  • The Ross procedure's durability concerns have limited its use, but perioperative risks relative to conventional aortic valve replacement are not well-defined.
  • This study investigates perioperative outcomes and utilization trends of the Ross procedure in adults.

Purpose of the Study:

  • To describe perioperative outcomes associated with the Ross procedure.
  • To analyze utilization trends of the Ross procedure in adult cardiac surgery.

Main Methods:

  • Utilized The Society of Thoracic Surgeons Adult Cardiac Surgery Database (1994-2010).
  • Assessed procedure utilization, patient demographics, preoperative comorbidities, and risk factors.
  • Analyzed intraoperative and perioperative outcomes using propensity-matching.
Keywords:
35

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Main Results:

  • Ross procedures accounted for 0.47% of aortic valve replacements, peaking at 1.2% in 1998 and declining to 0.09% by 2010.
  • Ross patients had significantly higher rates of reexploration (9.4% vs. 5.8%), renal failure (2.6% vs. 0.8%), and operative mortality (2.7% vs. 0.9%).
  • Over a quarter of Ross operations were concentrated at six surgical sites.

Conclusions:

  • The Ross procedure is linked to increased perioperative morbidity and mortality compared to conventional aortic valve replacement.
  • Awareness of these risks, coupled with durability issues, has driven a substantial decrease in Ross procedure adoption in North America.