Rethinking the ross procedure in adults.
BACKGROUND
Although questionable durability has tempered enthusiasm for the Ross procedure in the last decade, the perioperative risks of the Ross procedure relative to conventional aortic valve replacement are not well described. The goal of this study is to describe both the perioperative outcomes and utilization trends of the Ross procedure in adults in The Society of Thoracic Surgeons Adult Cardiac Surgery Database.


METHODS
The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to review all Ross procedures performed between 1994 and 2010. The utilization of the procedure in the database was assessed. Then the preoperative comorbidities, patient demographics, and risk factors were reviewed, as were intraoperative and perioperative outcomes.


RESULTS
Of 648,541 aortic valve replacements during the study period, 3,054 (0.47%) were identified as Ross procedures. Utilization of the procedures as a percent of total aortic valve replacements peaked in 1998 at 1.2%, followed by a steady decline to 0.09% by 2010. More than a quarter of all Ross operations were performed at six sites. Using propensity-matching analyses, Ross patients experienced significantly more perioperative complications including reexploration (9.4% versus 5.8%; p < 0.01), renal failure (2.6% versus 0.8%; p < 0.001), and operative mortality (2.7% versus 0.9%; p = 0.001).


CONCLUSIONS
These data suggest that the Ross procedure is associated with greater perioperative morbidity and mortality risks compared with conventional aortic valve replacement. Recognition of these risks along with durability concerns have resulted in a dramatic decline in the number of Ross procedures performed in North America in the last decade.
Department of Surgery, University of Colorado, Denver, Colorado. Electronic address: brett.reece@ucdenver.edu.
T Brett
TB
Reece
Division of Cardiothoracic Surgery, Oregon Health Sciences Center, Portland, Oregon.
Karl F
KF
Welke
Duke Clinical Research Institute, Durham, North Carolina.
Sean
S
O'Brien
Duke Clinical Research Institute, Durham, North Carolina.
Maria V
MV
Grau-Sepulveda
Department of Surgery, University of Colorado, Denver, Colorado.
Frederick L
FL
Grover
Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland.
James S
JS
Gammie
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D016208:Databases, Factual; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011664:Pulmonary Valve / Q000601:surgery / Q000637:transplantation*; D018570:Risk Assessment; D012955:Societies, Medical; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States
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