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The Ross Procedure: Determinants of Long-Term Durability
Nabil Ajmi1, Arman Sarshoghi1, Ismail Bouhout1
1Cardiac Surgery Department, Montreal Heart Institute, Montreal, Canada.
The Annals of Thoracic Surgery
|August 10, 2026
Summary
While survival and reintervention rates are similar after the Ross procedure, women experience greater aortic regurgitation progression and worse functional status, highlighting sex-specific differences in valvular heart disease outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Sex-Based Medicine
Background:
- Sex-related differences in valvular heart disease are increasingly recognized.
- Contemporary Ross procedure literature rarely reports outcomes by sex.
- This study evaluated sex-specific outcomes following the Ross procedure in a high-volume center.
Purpose of the Study:
- To evaluate sex-specific outcomes following the Ross procedure.
- To compare overall survival and freedom from reintervention between sexes.
- To assess sex-specific differences in aortic regurgitation, pulmonary regurgitation, and functional status post-Ross procedure.
Main Methods:
- Retrospective cohort study of adults undergoing Ross procedure (2011-2025).
- Propensity score matching (2:1 male:female) using 24 preoperative variables.
- Primary outcomes: overall survival, freedom from reintervention. Secondary outcomes: aortic regurgitation, pulmonary regurgitation, NYHA functional class, echocardiographic changes.
Main Results:
- Among 512 matched patients (337 male, 175 female), early outcomes were similar.
- Ten-year survival (96.4% male vs 92.9% female) and reintervention rates (5.0% vs 2.7%) were comparable.
- Females showed higher aortic regurgitation progression (11.0% vs 20.5%, P=0.005) and worse NYHA functional class.
Conclusions:
- Ross procedure survival and reintervention rates are comparable between sexes.
- Women experience significantly greater aortic regurgitation progression post-Ross procedure.
- Sex-specific differences in postoperative remodeling and functional status warrant further investigation.