Clinical Outcomes Following the Ross Procedure in Adults: A 25-Year Longitudinal Study

J Am Coll Cardiol. 2017 Oct 10;70(15):1890-1899. doi: 10.1016/j.jacc.2017.08.030.

Abstract

Background: Very few reports of long-term outcomes of patients who underwent the Ross procedure have been published.

Objectives: The authors reviewed their 25-year experience with the Ross procedure with the aim of defining very-long-term survival and factors associated with Ross-related failure.

Methods: Between January 1990 and December 2014, the Ross procedure was performed in 310 adults (mean age 40.8 years) at a single institution. All patients were prospectively added to a dedicated cardiac surgery registry. Complete post-operative clinical examination and history were obtained, and transthoracic echocardiography was performed according to a standardized protocol. There was no loss to follow-up. Median follow-up was 15.1 years and up to 25 years.

Results: Bicuspid aortic valve was diagnosed in 227 patients (73.2%), and the most common indication for surgery was aortic stenosis (n = 225 [72.6%]). Freedom from any Ross-related reintervention was 92.9% and 70.1% at 10 and 20 years, respectively. Independent risk factors for pulmonary autograft degeneration were pre-operative large aortic annulus (hazard ratio: 1.1; p = 0.01), pre-operative aortic insufficiency (hazard ratio: 2.7; p = 0.002), and concomitant replacement of the ascending aorta (hazard ratio: 7.7; p = 0.0003). There were 4 hospital deaths (1.3%), and overall survival at 10 and 20 years was 94.1% and 83.6%, respectively. Long-term survival was not significantly different in patients who required Ross-related reintervention (log-rank p = 0.70). However, compared with the general population, survival was significantly lower in patients following the Ross procedure when matched on age and sex (p < 0.0001).

Conclusions: The Ross procedure was associated with excellent long-term valvular outcomes and survival, regardless of the need for reintervention. Adults presenting with aortic insufficiency or a dilated aortic annulus or ascending aorta were at greater risk for reintervention. Unlike previous reports, long-term survival was lower in Ross patients compared with matched subjects.

Keywords: Ross; aortic valve surgery; pulmonary autograft.

MeSH terms

  • Adult
  • Aortic Valve / abnormalities*
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery
  • Aortic Valve Insufficiency* / etiology
  • Aortic Valve Insufficiency* / surgery
  • Aortic Valve Stenosis* / etiology
  • Aortic Valve Stenosis* / surgery
  • Bicuspid Aortic Valve Disease
  • Canada / epidemiology
  • Cardiac Valve Annuloplasty* / adverse effects
  • Cardiac Valve Annuloplasty* / methods
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / surgery
  • Female
  • Heart Valve Diseases* / complications
  • Heart Valve Diseases* / diagnosis
  • Heart Valve Diseases* / epidemiology
  • Heart Valve Diseases* / surgery
  • Humans
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / etiology
  • Long Term Adverse Effects* / physiopathology
  • Long Term Adverse Effects* / therapy
  • Male
  • Outcome and Process Assessment, Health Care
  • Platelet Aggregation Inhibitors / therapeutic use
  • Postoperative Period
  • Pulmonary Valve* / diagnostic imaging
  • Pulmonary Valve* / surgery
  • Registries
  • Replantation* / adverse effects
  • Replantation* / methods
  • Time

Substances

  • Platelet Aggregation Inhibitors