Cardiac Surgery Fellow Cleveland Clinic Québec, Quebec, Canada
Background: There is a renewed interest for the Ross procedure in adults following several studies showing good early and mid-term outcomes. Yet, few studies have reported on the outcomes of pulmonary autografts in the second and third postoperative decade.
METHODS AND RESULTS:
Methods: This is a retrospective study of a prospectively collected database. Between 1990 and 2025, 555 adults underwent a Ross procedure in our institution. Of these, 68 (12.3%) required reoperation on the aortic valve and form the cohort for this study. The mean follow-up is 20.4±8.7, and 100% complete.
Results: Among patients (37% female) who underwent a reintervention during follow-up, the mean age at the time of the index Ross procedure was 39.9 ± 11.7 years. Thirteen patients (19%) had a previous cardiac intervention. The main indication for surgery was aortic stenosis in 47 patients (69%). Thirty-two patients (47%) had moderate-severe aortic regurgitation. Autograft reintervention occurred after a mean follow-up of 12.3 ± 8.0 years. Mean age at the time of reoperation was 51.9 ± 13.9 years old. The main cause of reintervention was aortic regurgitation (98%). A valve-sparing root replacement was performed in 19 patients (28%) and 26 patients (38%) underwent a Bentall procedure. An aortic valve replacement was performed in 20 patients (29%), 2 patients (3%) had an aortic valve repair, and 1 patient (2%) underwent a transcatheter valve implantation. There was 1 perioperative death. Survival after autograft reintervention was 84.9% at 10 years. Cumulative incidence of autograft reintervention at 10, 20, and 30 years was 6.7%, 20.0%, and 25.7%, respectively (Figure 1). This cumulates to an annualized rate of reintervention of 0.8%/year.
Conclusion: In this large cohort with complete longitudinal follow-up, the Ross procedure offers good long-term durability. Reintervention on the autograft occurs at an annualized rate of 0.8%/year and is safe, when performed in dedicated centers. In this study, the pulmonary autograft could be spared in almost a third of patients, allowing to preserve most of the benefits of the Ross procedure.
