Ross procedure: Evidence for pulmonary autograft and early outcomes *

Abstract

Background

Renewed interest in the Ross procedure in young adults has been tempered by questions over safety and early outcomes. This paper examines our institution's 1-year outcomes of the Ross procedure.

Methods

From November 2019 to February 2025, 136 consecutive adult patients underwent a Ross procedure at an urban tertiary center. The first 50 patients had follow-up beyond 1 year and constitute the study group of this case series.

Results

Median age was 41 years (IQR: 30, 47). The majority were male (n = 34, 68%). The most common indication for surgery was aortic stenosis with or without aortic regurgitation (AR) (n = 34, 68%), followed by pure AR (n = 14, 28%), then aortic aneurysm with valve dysfunction (n = 2, 4%). Valve morphology was bicuspid in 22 (44%) patients, unicuspid in 21 (42%), and tricuspid in 5 (10%). Primary etiology was congenital in 42 (84%) patients, degenerative in 2 (4%), failed mechanical valve in 2 (4%), healed endocarditis in 1 (2%), rheumatic disease in 1 (2%), radiation-induced in 1 (2%), and unknown in 1 (2%). Redo sternotomy was performed in 2 (4%) patients, ascending aorta replacement in 43 (86%), hemiarch replacement in 22 (44%), and external aortic annuloplasty ring in 23 (46%). In-hospital and 30-day mortality was 0%, with 2 (4%) permanent strokes post-operatively but with no or minimal residual deficits. There was 1 mortality at 1.1 years, 1 autograft re-intervention at 1.8 years, 1 autograft re-intervention at 4.1 years, and 1 homograft re-intervention at 2.7 years.

Conclusion

This paper demonstrates early safety of the Ross procedure for adults. More longitudinal data is needed to determine long-term efficacy and durability.