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Expanding Eligibility for the Ross Procedure: A Reasonable Proposition?
Aly Ghoneim1, Ismail Bouhout1, Katie Losenno2
1Department of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Montreal, Québec, Canada.
The Canadian Journal of Cardiology
|May 3, 2018
Summary
The Ross procedure is safe for young adults, even in complex cases. While higher-risk patients had slightly longer hospital stays, mortality and major complications were similar to standard procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Valve Surgery
Background:
- The Ross procedure offers benefits for young adults but faces challenges due to technical complexity.
- Expanding the Ross procedure to higher-risk patients requires careful evaluation of safety and outcomes.
Purpose of the Study:
- To compare early outcomes of standard isolated Ross procedures with those in higher-risk clinical settings.
Main Methods:
- A prospective study of 261 patients undergoing Ross procedures between 2011 and 2016.
- Patients were divided into standard (n=166) and expanded eligibility (n=95) groups.
- Expanded criteria included prior cardiac surgery, endocarditis, impaired left ventricular function, or concomitant procedures.
Main Results:
- Hospital mortality was 0% in the standard group versus 2% in the expanded group (P=0.13).
- Acute renal injury occurred in 10% of the standard group and 14% of the expanded group (P=0.31).
- Intensive care unit (ICU) and hospital stays were longer in the expanded group (3 vs 2 days ICU, 7 vs 6 days hospital).
Conclusions:
- The Ross procedure is a safe alternative for young adults in specialized centers, even when expanding eligibility to higher-risk patients.
- Perioperative mortality and morbidity are comparable between standard and expanded Ross procedures, with only slightly longer hospital stays for higher-risk cases.
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