Ross procedure: Evidence for pulmonary autograft and early outcomes

BackgroundRenewed interest in the Ross procedure in young adults has been tempered by questions over safety and early outcomes. This paper examines our institution's 1-year outcomes of the Ross procedure.MethodsFrom November 2019 to February 2025, 136 consecutive adult patients underwent a Ross procedure at an urban tertiary center. The first 50 patients had follow-up beyond 1 year and constitute the study group of this case series.ResultsMedian age was 41 years (IQR: 30, 47). The majority were male (n = 34, 68%). The most common indication for surgery was aortic stenosis with or without aortic regurgitation (AR) (n = 34, 68%), followed by pure AR (n = 14, 28%), then aortic aneurysm with valve dysfunction (n = 2, 4%). Valve morphology was bicuspid in 22 (44%) patients, unicuspid in 21 (42%), and tricuspid in 5 (10%). Primary etiology was congenital in 42 (84%) patients, degenerative in 2 (4%), failed mechanical valve in 2 (4%), healed endocarditis in 1 (2%), rheumatic disease in 1 (2%), radiation-induced in 1 (2%), and unknown in 1 (2%). Redo sternotomy was performed in 2 (4%) patients, ascending aorta replacement in 43 (86%), hemiarch replacement in 22 (44%), and external aortic annuloplasty ring in 23 (46%). In-hospital and 30-day mortality was 0%, with 2 (4%) permanent strokes post-operatively but with no or minimal residual deficits. There was 1 mortality at 1.1 years, 1 autograft re-intervention at 1.8 years, 1 autograft re-intervention at 4.1 years, and 1 homograft re-intervention at 2.7 years.ConclusionThis paper demonstrates early safety of the Ross procedure for adults. More longitudinal data is needed to determine long-term efficacy and durability.