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Updated: Nov 12, 2025
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Published on: April 1, 2022
Long-Term Outcomes of Patients Undergoing the Ross Procedure
Anas Aboud1, Efstratios I Charitos2, Buntaro Fujita1
1Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck Campus, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Lübeck, Germany.
The Ross procedure offers excellent long-term survival for young patients with aortic-valve disease, comparable to the general population. Reintervention and complication rates are notably low, making it a suitable treatment option.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Adult Congenital Heart Disease
Background:
- Aortic-valve disease in young patients presents unique treatment challenges.
- The Ross procedure, utilizing autograft replacement, shows promise for improved long-term outcomes.
Purpose of the Study:
- To report long-term outcomes of the Ross procedure in adult patients.
- To identify risk factors for survival and reintervention after the Ross procedure.
Main Methods:
- Analysis of adult patients from the Ross Registry (1988-2018).
- Evaluation of overall survival, reintervention rates, and major adverse events.
- Multivariable regression to determine predictors of survival and reintervention.
Main Results:
- Estimated 25-year survival was 75.8%, not significantly different from the general population.
- Low rates of autograft (0.69%/patient-year) and RVOT reintervention (0.62%/patient-year).
- Predictors for autograft reintervention included larger annulus diameter and pure aortic insufficiency; RVOT reintervention predictors were biological valve use and younger patient age.
Conclusions:
- The Ross procedure demonstrates excellent long-term survival (up to 25 years) for aortic-valve disease.
- Low rates of reintervention, anticoagulation-related morbidity, and endocarditis support its efficacy.
- The Ross procedure is a highly suitable treatment option for young patients with aortic-valve disease.
