The Ross Procedure: A Fifteen-year Experience

Abstract

Background

The Ross procedure was introduced in 1967 as a surgical treatment for aortic valve stenosis. Since then, the procedure has been used worldwide and has well-known advantages and disadvantages. However, the complexity of the procedure has limited its use and concern exists about the durability of valve substitutes.

Objective
To analyze the long-term outcomes of the Ross procedure in the treatment of aortic valve disease performed at the
Hospital Universitario Fundación Favaloro.

Methods

Between July 1995 and May 2011, 253 consecutive patients underwent the Ross procedure. Three patients were excluded: two patients reoperated on due to an indication that was not related with the Ross procedure and one patient with iatrogenic injury of the autograft. All patients underwent clinical and echocardiographic follow-up. Survival rates, absence of autograft or homograft reoperation and of valve-related events (death, reoperation, thromboembolism, bleeding and endocarditis) were analyzed using Kaplan-Meier curves, Wilcoxon test and log rank test.

Results

Mean age was 42±14 years; 72% were men. Surgery was indicated due to aortic stenosis in 50% of cases, aortic regurgitation in 36% and aortic valve disease in 14%. Bicuspid aortic valve was the most common etiology (77%). Isolated procedures were
performed in 85% of cases. In-hospital mortality was 3.2%. The overall survival rates at 5 years and 12 years were 95% (95%
CI 90-97%) and 92% (95% CI 83-96%), respectively. Autograft dysfunction occurred in 13% of patients (5%). Freedom from
autograft reoperation was 100% at 5 years and 95% at 12 years (95% CI 87-98%). Homograft dysfunction occurred in
24 patients (10%). Freedom from homograft reoperation was 99% at 5 years and 12 years (95% CI 95-99.9%). There was
no correlation between preoperative aortic regurgitation and reoperation. The absence of valve-related events was 89% (95%
CI 82-94%) at 10 years and 85% at 12 years (95% CI 75-91%).

Conclusion

In our experience, the Ross procedure was associated with a low long-term event rate, representing a valid surgical approach for the treatment of aortic valve disease.