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

The Ross procedure is a valuable option for aortic valve replacement in young patients, but concerns about autograft durability and limited homograft availability, especially in resource-limited settings, have limited its use. This study evaluated long-term outcomes of the Ross procedure, with a focus on the effectiveness of handmade Dacron (polyethylene terephthalate, Getinge/Maquet) valved conduits as an alternative to homografts.

The study retrospectively reviewed 252 patients (mean age, 19.6 [SD12.5] years) who underwent the Ross procedure between 2001 and 2023 at a single center (Narayana Health, Bengaluru, India). Pulmonary artery reconstruction was performed using pulmonary homografts (n = 176) or handmade Dacron valve conduits (n = 75). Long-term outcomes, including mortality, reintervention, and valve function, were analyzed using Kaplan-Meier estimates and multivariate regression models.

Early mortality was 1.6%. Median follow-up was 6.4 years (interquartile range, 0.8-15 years). At 10 years, freedom from all-cause mortality was 94.3% (95% CI, 91.0-97.7), and freedom from Ross-related reintervention was 89% (95% CI, 84-94). Ross-related reinterventions were performed in 16 (6%) cases, 13 surgical (8 autograft, 5 pulmonary conduit) and 3 balloon valvuloplasties for conduit stenosis. Dacron valved conduits had similar mean right ventricular outflow tract gradients (17.5 [ 9.9] mm Hg vs 16.5 [12.7] mm Hg; P = .75) and comparable overall reintervention rates (2.6% vs 3.4%; P = .93). Younger age was the only independent predictor of late aortic regurgitation (adjusted odds ratio, 0.90; 95% CI, 0.82--0.98; P = .01).

The Ross procedure demonstrates excellent long-term survival and valve durability in young patients. Dacron valve conduits offer a safe and effective alternative to homografts for pulmonary valve replacement.