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Updated: Aug 15, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement
Ismail Bouhout1, Pierre-Emmanuel Noly1, Aly Ghoneim1
1Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Objectives:
The aim of this study was to compare perioperative outcomes in young adults following isolated Ross procedure versus mechanical aortic valve replacement (AVR) in a high-volume centre.
Methods:
From 2007 to 2015, 337 elective isolated mechanical AVRs and 137 Ross procedures were performed in young adults (<65 years) at our centre. Using a 1:1 propensity score match analysis, 140 patients were included in the study (n = 70 in each group). Perioperative outcomes were defined using STS guidelines. The primary outcome was operative mortality.
Results:
Median age was 52 [14] years and EuroSCORE II was 1.0 [0.4]%. There were no mortalities in the two groups. There were no differences in the incidence of myocardial injury (0% overall) and neurological complications (0.7% overall). Three (4%) reinterventions for bleeding were required in the Ross cohort versus six (9%) in the mechanical AVR cohort (P = 0.49). A significant increase in serum creatinine (>2-fold increase) was more commonly observed after the Ross procedure (11 vs 1%; P = 0.03), but there was no significant difference in the rate of temporary dialysis. Twenty-seven patients (39%) required ≥1 blood product transfusion in the Ross group, whereas 21 patients (31%) did so in the mechanical AVR group (P = 0.47). Median hospital length of stay was similar in both the groups (6 days).
Conclusions:
There are no differences in mortality or major perioperative outcomes in adults undergoing an isolated Ross procedure or mechanical AVR.
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