The Ross Procedure in Young and Middle-Aged Patients: Long term outcomes.

BACKGROUND

Ross procedure is a valuable option for aortic valve replacement in young patients, but concerns about autograft durability and limited homograft availability, especially in resource-limited settings, have limited its use. This study evaluated long-term outcomes of the Ross procedure, focusing on the effectiveness of hand-made Dacron valved conduits as an alternative to homografts.

METHODS

We retrospectively reviewed 252 patients (mean age 19.6 ± 12.5 years) who underwent the Ross procedure between 2001 and 2023 at a single center. Pulmonary artery reconstruction was performed using pulmonary homografts (n=176) or hand-made Dacron valve conduits (n=75). Long-term outcomes including mortality, reintervention, and valve function were analyzed using Kaplan-Meier estimates and multivariate regression models.

RESULTS

Early mortality was 1.6%. Median follow up was 6.4 years (IQR 0.8-15 years). At 10 years, freedom from all-cause mortality was 94.3% (95% CI: 91.0-97.7), and freedom from Ross-related reintervention was 89% (95% CI: 84-94). Ross-related reinterventions were performed in 16(6%) cases, 13 surgical(8 autograft, 5 pulmonary conduit) and 3 balloon valvuloplasties for conduit stenosis. Dacron valved conduits had similar mean right ventricular outflow tract gradients (17.5 ± 9.9 vs. 16.5 ± 12.7 mmHg, p=0.75) and comparable overall reintervention rates (2.6% vs. 3.4%, p=0.93). Younger age was the only independent predictor of late aortic regurgitation (adjusted OR 0.90; 95% CI: 0.82-0.98, p = 0.01).

CONCLUSIONS

The Ross procedure demonstrates excellent long-term survival and valve durability in young patients. Dacron valve conduits offer a safe and effective alternative to homografts for pulmonary valve replacement.