The Ross Procedure : Outdated or Up-to-date?

Abstract

Background: The Ross procedure uses a patient’s own pulmonary valve to replace the diseased aortic valve. It is an alternative to conventional valve replacement especially in the younger patient population. This patient group, and patients with contraindications against conventional valve re- p lacements, may benefit from a Ross procedure if it can be performed safely and with adequate durability. The aim of this study was to assess the reproducibility, survival, and durability of pulmo- nary autograft replacements in our institution. Methods: Bet ween December 1995 and December 2020, 202 patients (male 73%; mean age 35.4±11.4 years) underwent the Ross procedure at our institution. Eight patients were lost to follow up and were excluded from the long term analysis. One patient was intraoperatively c onverted to a Bentall procedure. Five patients underwent a cylinder Ross procedure and 196 patients a full root replacement. Aortic v alve morphology was unicuspid in 87 ( bicuspid in 76 ( and tricus- pid in 25 ( patients. Fourteen patients had undergone valve replacement previously, and the morphology could not be determined. Results: Overall, 202 patients were analyzed, 10 patients died, and 8 patients were lost to follow up. The pulmonary valve was replaced with a ho mograft in 156 patients, with a bovine jugular vein graft in 35 patients, and in 10 patients with a stentless bio logical valve prosthesis Mean myocardial ischemia time was 91±20minutes; mean perfusion time was 125±33 minutes. Fifty eight patients required a concomitant procedure during their Ross operation, most commonly as- cending aortic replacement (n= There was one perioperative death, no myocardial infarction, and one neurological complication. A permanent pacemaker was implanted in four cases ( There was one late deat h from a non cardiac cause. Twenty three patients required reinterventions after the Ross procedure (pulmonary autograft n=16, pulmonary conduit n= 7). A valve sparing pro- cedure was performed in the majority of cases. At 10 years, survival was 93%, simila r to that of the age and gender matched German population. Freedom from autograft reintervention at 10 years was 89% and freedom from RV PA reintervention was 93%. Median and mean follow up were 5.7 [range 0.1 24.4] years and 7.8 ±7 years. Clinical and echocardiography follow up were 95% and 92% complete (1467 patient years). Conclusion The Ross procedure represents a safe and valid option in young and middle aged patients. It is associated with low perioperative morbidity and mortality. The probabilit y of reinterven- tions is low and long term survival is excellent, similar to that of the age and gender matched gen- eral German population.