Late results of the Ross Procedure.

Abstract

Most studies on the Ross procedure describe outcomes during the first 2 decades. The present report describes the outcomes at 30 years. From 1990 to 2004, 212 consecutive patients with a median age of 34 years underwent the Ross procedure. Freestanding aortic root replacement was used in 108 patients, and aortic root inclusion in 104. Patients have been followed prospectively for a median of 26.6 years. Valve function was assessed by echocardiography at periodic intervals. Adverse events were assessed using appropriate statistical analyses. Patients' 30-year survival was 79.4% (95% CI, 71.1%-85.6%), 9.1% lower than that of the Canadian general population matched for sex and age. Forty-seven (22%) patients required Ross-related reinterventions, totaling 64 surgical and 12 percutaneous procedures. Cumulative incidences at 30 years for any Ross-related reinterventions were 28.4% (95% CI - 21.8%, 37.1%), for pulmonary autograft reoperation was 19.1% (95% CI - 13.7%, 26.6%), and for pulmonary homograft was 17.1% (95% CI -1 1.9%, 24.7%). Dilated aortic annulus, older age, and freestanding aortic root replacement were associated with reoperation on the autograft by multivariable analysis. At 30 years, the cumulative incidence of autograft dysfunction (aortic insufficiency and stenosis) was 38.0% [95% CI 31.4%, 46.0%], and pulmonary homograft dysfunction was 62.6% (95% CI - 54.2%, 72.3%). The Ross procedure is a good aortic valve substitute for young adults, but it does not restore normal lifespan, and the function of both valves deteriorates over time, including the development of autograft valve stenosis.