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).

Centre of Cardiovascular Surgery and Transplantation Brno Czech Republic

Department of Cardiac and Thoracic Vascular Surgery University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Campus Lübeck Germany

Department of Cardiac and Thoracic Vascular Surgery University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Campus Lübeck Germany; German Center for Cardiovascular Research Partner Site Lübeck Lübeck Germany

Department of Cardiac and Vascular Surgery Robert Bosch Hospital Stuttgart Germany

Department of Cardiac Surgery Medical University of Vienna Vienna Austria

Department of Cardiac Surgery University of Bonn Bonn Germany

Department of Cardiology University Hospital Schleswig Holstein Lübeck Campus Lübeck Germany

Department of Cardiovascular Surgery German Heart Center Munich Germany

Department of Cardiovascular Surgery University Heart Center Hamburg Hamburg Germany

Department of Cardiovascular Surgery University Hospital Würzburg Würzburg Germany

Department of Congenital Heart Disease and Paediatric Cardiology German Heart Center Berlin Germany

Department of Thoracic and Cardiovascular Surgery University Hospital Frankfurt Frankfurt Germany

Sana Cardiac Surgery Stuttgart Stuttgart Germany

J Am Coll Cardiol. 2021 Mar 23;77(11):1423-1425. doi: 10.1016/j.jacc.2021.01.041. PubMed

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Comparison of bicuspidization and Ross procedure in the treatment of unicuspid aortic valve disease in adults - Insight from the AVIATOR registry

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ClinicalTrials.gov
NCT00708409