The Ross Procedure in Young and Middle-Aged Patients: Long-Term Outcomes

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Pediatric Cardiac Surgery

Background:

• The Ross procedure is a preferred aortic valve replacement in young patients.
• Concerns regarding autograft durability and homograft availability limit its use.
• This study assesses long-term outcomes of the Ross procedure, evaluating Dacron valved conduits as a homograft alternative.

Purpose of the Study:

• To evaluate the long-term effectiveness and safety of the Ross procedure.
• To compare outcomes between pulmonary homografts and handmade Dacron valved conduits.
• To identify predictors of adverse events after the Ross procedure.

Main Methods:

• Retrospective review of 252 patients undergoing the Ross procedure (2001-2023).
• Pulmonary artery reconstruction using homografts (n=176) or Dacron valved conduits (n=75).
• Analysis of mortality, reintervention, and valve function using Kaplan-Meier estimates and multivariate regression.

Main Results:

• Early mortality was 1.6%; 10-year freedom from mortality was 94.3%.
• 10-year freedom from Ross-related reintervention was 89%.
• Dacron conduits showed comparable gradients and reintervention rates to homografts; younger age predicted late aortic regurgitation.

Conclusions:

• The Ross procedure offers excellent long-term survival and valve durability in pediatric and young adult patients.
• Handmade Dacron valved conduits are a safe and effective alternative to homografts for pulmonary valve replacement.
• The Ross procedure remains a viable option for aortic valve replacement in young individuals, with Dacron conduits addressing homograft limitations.