Long-Term Outcomes of Patients Undergoing the Ross Procedure

J Am Coll Cardiol. 2021 Mar 23;77(11):1412-1422. doi: 10.1016/j.jacc.2021.01.034.

Abstract

Background: Treatment of aortic-valve disease in young patients still poses challenges. The Ross procedure offers several potential advantages that may translate to improved long-term outcomes.

Objectives: This study reports long-term outcomes after the Ross procedure.

Methods: Adult patients who were included in the Ross Registry between 1988 and 2018 were analyzed. Endpoints were overall survival, reintervention, and major adverse events at maximum follow-up. Multivariable regression analyses were performed to identify risk factors for survival and the need of Ross-related reintervention.

Results: There were 2,444 adult patients with a mean age of 44.1 ± 11.7 years identified. Early mortality was 1.0%. Estimated survival after 25 years was 75.8% and did not statistically differ from the general population (p = 0.189). The risk for autograft reintervention was 0.69% per patient-year and 0.62% per patient-year for right-ventricular outflow tract (RVOT) reintervention. Larger aortic annulus diameter (hazard ratio [HR]: 1.12/mm; 95% confidence interval [CI]: 1.05 to 1.19/mm; p < 0.001) and pre-operative presence of pure aortic insufficiency (HR: 1.74; 95% CI: 1.13 to 2.68; p = 0.01) were independent predictors for autograft reintervention, whereas the use of a biological valve (HR: 8.09; 95% CI: 5.01 to 13.08; p < 0.001) and patient age (HR: 0.97 per year; 95% CI: 0.96 to 0.99; p = 0.001) were independent predictors for RVOT reintervention. Major bleeding, valve thrombosis, permanent stroke, and endocarditis occurred with an incidence of 0.15% per patient-year, 0.07% per patient-year, 0.13%, and 0.36% per patient-year, respectively.

Conclusions: The Ross procedure provides excellent survival over a follow-up period of up to 25 years. The rates of reintervention, anticoagulation-related morbidity, and endocarditis were very low. This procedure should therefore be considered as a very suitable treatment option in young patients suffering from aortic-valve disease. (Long-Term Follow-up After the Autograft Aortic Valve Procedure [Ross Operation]; NCT00708409).

Keywords: Ross procedure; aortic valve replacement; long-term outcomes; pulmonary autograft; right-ventricular outflow tract.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aortic Valve Disease* / diagnosis
  • Aortic Valve Disease* / epidemiology
  • Aortic Valve Disease* / surgery
  • Aortic Valve* / pathology
  • Aortic Valve* / surgery
  • Echocardiography / methods
  • Female
  • Germany / epidemiology
  • Heart Valve Prosthesis / adverse effects
  • Heart Valve Prosthesis / statistics & numerical data
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis Implantation* / methods
  • Humans
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / epidemiology
  • Long Term Adverse Effects* / etiology
  • Male
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / surgery
  • Prognosis
  • Registries / statistics & numerical data
  • Reoperation* / classification
  • Reoperation* / methods
  • Reoperation* / statistics & numerical data
  • Risk Assessment / methods
  • Risk Factors
  • Survival Analysis
  • Transplantation, Autologous* / adverse effects
  • Transplantation, Autologous* / methods
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT00708409