title: Long-term outcomes of the Ross procedure in adults with severe aortic stenosis: single-centre experience with 20 years of follow-up.
abstract: OBJECTIVE
  The optimal prosthesis option for aortic valve replacement in adult patients<60 years of age with severe aortic stenosis (AS) remains controversial. The objective was to determine the long-term outcomes of the Ross procedure in this population.
  
  
  METHODS
  Between 1990 and 2013, 276 patients aged 18 years and above (mean 40.3±10.6) underwent an elective Ross procedure. Among them, 221 patients had predominant severe AS; these patients form the study group. The Ross procedure was performed either by aortic root replacement (n=190; 86%) or the subcoronary technique (n=31; 14%). There were 169 patients with bicuspid valves and 33 redo operations including previous aortic valve repair (n=6) and replacement (n=9) for severe AS. Demographic, preoperative, postoperative and longitudinal clinical and echocardiographic data were collected prospectively. The median and mean follow-up were 11.4 years (range: 1-20.1 years) and 10.1±5.9 years, respectively. The follow-up was complete in all patients. Kaplan-Meier actuarial survival analysis was performed to assess long-term survival, freedom from reoperation for autograft and/or homograft failure and freedom from autograft valve insufficiency. Cox regression risk analysis was performed to identify factors associated with autograft or homograft reoperations.
  
  
  RESULTS
  The perioperative mortality rate was 0.9% (n=2). The incidence rate of early reoperation for bleeding was 5.9%. The actuarial survival rate at 10 and 15 years following surgery was 92.1 and 90.5%, respectively. Ross-related reoperations occurred in 21 patients during follow-up: autograft dysfunction (n=9), homograft dysfunction (n=6) and both (n=6). The rate of freedom from Ross-related reoperation was 94.7 and 87.7% at 10 and 15 years, respectively. The rate of freedom from reoperation for autograft failure was 97.6 and 91.5%, the rate of freedom from reoperation for homograft failure was 95.7 and 90.8%, and the rate of freedom from moderate or severe autograft regurgitation was 94.1 and 85.6% at 10 and 15 years, respectively.
  
  
  CONCLUSIONS
  Compared with available aortic bioprosthetic alternatives in young adults with severe AS, the Ross procedure provides an excellent long-term option for patients with predominant severe AS who seek a durable operation without anticoagulation.
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada siamak.mohammadi@fmed.ulaval.ca.
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Kalavrouziotis
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: Mounir
authors.initials: M
authors.lastname: Kharroubi
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Marzouk
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Metras
authors.affiliation: Division of Cardiac Surgery, Quebec Heart and Lung University Hospital, Quebec City, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Perron
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic valve replacement; Autograft dysfunction; Homograft dysfunction; Ross procedure