Related Experiment Video
Updated: Dec 14, 2025
A Rodent Model of The Ross Operation: Syngeneic Pulmonary Artery Graft Implantation in A Systemic Position
Published on: April 1, 2022
The long term results of the Ross procedure: The importance of candidate selection
Valeria Pergola1, Giovanni Di Salvo1, Bahaa Fadel1
1The Heart Centre, King Faisal Specialist Hospital and research centre, Riyadh, Saudi Arabia.
Insights
The Ross procedure offers excellent survival and low reoperation rates for aortic valve disease, especially in younger patients. Fresh preserved pulmonary homografts show better long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- The Ross procedure is a preferred aortic valve replacement in children due to potential aortic annulus growth and no need for anticoagulation.
- It is associated with a low morbidity rate and excellent survival outcomes.
Purpose of the Study:
- To evaluate the long-term outcomes of the Ross procedure in a large cohort of patients.
- To identify ideal candidates and assess the performance of different homograft types.
Main Methods:
- A retrospective analysis of 536 patients who underwent the Ross procedure between 1990 and 2016.
- Patients were divided into two groups based on age at surgery (under 18 vs. over 18).
- Complete clinical and echocardiographic follow-up was performed, with a mean follow-up of 16.3 years.
Main Results:
- Overall freedom from reoperation or reintervention was 78% at 20 years.
- Freedom from redo surgery for the aortic valve was 80% at 20 years, and for the pulmonary valve was 76% at 20 years.
- Patients with congenital aetiology and aortic root diameter ≤ 15 mm/m² are ideal candidates, with fresh preserved pulmonary homografts showing better long-term performance.
Conclusions:
- The Ross procedure demonstrates favorable long-term results, including low reoperation rates, particularly in younger patients.
- Optimal patient selection and the use of fresh preserved pulmonary homografts are crucial for maximizing long-term success.
Abstract:
The Ross procedure has been considered in children as an optimal surgical procedure due to potential growth of the aortic annulus, lack of anticoagulation requirement, very low morbidity rate and excellent survival. Five-hundred-thirty-six (366 male, mean age 29.4 ± 11.1 years) underwent Ross procedure between 1990 and 2016 and had complete clinical and echocardiographic follow-up. Mean follow-up was 16.3 ± 4.9 years. Patients were divided in 2 groups according to age at surgery. Group 1 consisted of 320 (60%) patients less than 18 years old (223 male, mean age at surgery of 9.5 ± 5.6 years). Group 2 consisted of 216 (40%) patients older than 18 years of age (143 male, mean age at surgery of 26.3 ± 8.2 years). One-hundred-thirty (24%) patients had a redo procedure or surgery. Freedom from all re-operation and or percutaneous reintervention on either the aortic and pulmonary valves was 99% after 1 year, 94% after 5 years, 89% after 10 years, 83% after 15 years and 78% after 20 years. Freedom from redo surgery for AV 99% after 1 year, 94% after 5 years, 90% after 10 years, 81% after 15 years and 80% after 20 years. Freedom from redo surgery for PV was 100% after 1 year, 95% after 5 years, 89% after 10 years, 78% after 15 years and 76% after 20 years. The ideal candidate for Ross operation is a patient with congenital aetiology and an aortic root diameter ≤ 15 mm/m2. A pulmonary fresh preserved homograft seems to perform better on the long term.
