The Ross procedure in young adults: over 20 years of experience in our Institution.
OBJECTIVE
The aim of this study was to evaluate the long-term outcomes following the Ross procedure in young adults in our institution.


METHODS
All adult patients who received a Ross operation between 1991 and 2014 were included in the study. Survival analysis and regression analysis were performed. Survival of the Ross cohort was compared with the age-, gender- and calendar year-matched general population.


RESULTS
Three hundred-and-six patients (mean age: 41.7 ± 9.7, male: 74.8%, bicuspid aortic valve: 58.5%, valve stenosis: 68%) were included in the analysis. There were 7 perioperative deaths (2.3%). Nine patients were lost to follow-up from hospital and completeness of the follow-up was 94%. The median follow-up of the remaining 290 patients was 10.6 years. There were 21 late deaths of which only 3 were valve-related. The overall survival at 15 years since surgery is 88 ± 3% that is comparable with the matched population. Freedom from valve-related deaths was 96.8 ± 2% at 16 years. Freedom from autograft and pulmonary homograft reoperation was 74.5 ± 4.3% at 16 years. Preoperative aortic regurgitation was the only significant predictor of autograft failure over time. Freedom from the combined end point of bleeding/thromboembolism/endocarditis/reoperation was 69.2 ± 4% at 16 years. Perioperative mortality following reoperation was 2.6% and the autograft could be spared in 72% of reinterventions.


CONCLUSIONS
The Ross operation in young adults is associated with an excellent survival in the long term that is comparable with the general population. Although there is a risk of reoperation, incidence of other valve-related events is very low. The use of pulmonary autograft should be considered in any young adult patient requiring aortic valve replacement.
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium stm919@mail.harvard.edu.
Stefano
S
Mastrobuoni
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Laurent
L
de Kerchove
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Silvia
S
Solari
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Parla
P
Astarci
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Alain
A
Poncelet
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Philippe
P
Noirhomme
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Jean
J
Rubay
Department of Cardiovascular and Thoracic Surgery, St Luc's Hospital, Catholic University of Louvain, Brussels, Belgium.
Gebrine
G
El Khoury
D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
Long-term outcomes; Ross procedure; Survival