Original article
Congenital heart surgery
A Single-Center Experience With the Ross Procedure Over 20 Years

https://doi.org/10.1016/j.athoracsur.2013.08.020Get rights and content

Background

The Ross procedure offers several potential advantages in a young patient population. The widespread use of the procedure is still limited due to the technical challenge. Pulmonary homograft stenosis and autograft dilatation remain a matter of concern. We present the long-term outcome in a single center with special emphasis on mortality and need for valvular reintervention.

Methods

All patients who received a Ross procedure as freestanding root replacement (modified Yacoub technique) at our institution between 1991 and 2011 were followed. Descriptive statistical methods and Kaplan-Meier analyses were performed.

Results

A total of 246 patients (191 males, 55 females) underwent the Ross procedure during the study period. There were 176 adults and 70 pediatric patients with an average age of 36 ± 10 and 10 ± 5 years, respectively. The median follow-up was 10 years. Twelve (4.9%) subjects were lost to follow-up. Early mortality was 1.6%. Overall mortality was comparable with an age and sex matched population for adult patients. The linearized risk for reoperation per patient-year was 0.6% for the autograft and 0.6% for the right ventricular outflow tract, with a mean time to surgery of 6.4 ± 4.9 years. Overall freedom from reintervention was 95% at 5 years, 88% at 10 years, and 81% at 15 years.

Conclusions

The Ross procedure provides good early results and an excellent long-term survival. It represents an excellent method of aortic valve replacement in children and young adults. Root reinforcement techniques and aortic reduction plasty may be beneficial, especially in adult patients with native aortic valve regurgitation.

Section snippets

Patients

All patients who underwent a Ross procedure with intra-annular implantation of the autograft as a freestanding root (modified Yacoub technique) at the Medical University of Vienna and Vienna General Hospital between 1991 and 2011 were included in this analysis. The Ross procedure was offered to eligible patients younger than 40 years by those surgeons at our institution who favored this operation. Furthermore, it was performed in older patients at their own request if considered as appropriate.

Results

A total of 246 patients underwent a Ross procedure during the study period. Aortic regurgitation was the most frequent indication for surgery (40%). Combined aortic lesions and aortic stenosis were less frequent (31% and 29%, respectively). Perioperative data are presented in Table 1, patient characteristics are depicted in Table 2, and preoperative aortic valve patterns are shown in Table 3. The mean and median follow-up durations were 9 ± 5 and 10 (4; 12) years, respectively. Twelve (4.9%)

Comment

We report herein the results of 246 Ross procedures performed in 20 years at a single center. It should be emphasized that in this series of patients, aortic regurgitation due to root dilatation as well as bicuspid aortic valve were not a contraindication to the Ross operation. In fact, 40% of our population presented with aortic regurgitation and 29% required a reduction of the ascending aorta.

Our outcome regarding survival and reoperations is similar to prior reports and underline the value

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