Age-Related Outcomes of the Ross Procedure Over 20 Years.
BACKGROUND
The Ross procedure is an alternative for patients with aortic valve disease not amenable to repair. Long-term follow-up after a Ross has demonstrated the need for autograft (left ventricular outflow tract [LVOT]) and homograft (right ventricular outflow tract [RVOT]) reinterventions. We assessed the age-stratified outcomes of the LVOT and RVOT after the Ross procedure performed by a single surgeon during a 20-year period.


METHODS
We retrospectively reviewed 305 consecutive patients aged 4 days to 70 years, stratified by age younger than than 1 (n = 41), 1 to 10 (n = 85), 10 to 20 (n = 84), 20 to 40 (n = 59), and older than 40 years (n = 36). Median follow-up was 8.2 years (interquartile range, 1 month to 19.2 years). Primary end points were survival and freedom from reintervention on the LVOT and RVOT. Outcomes were compared by Kaplan-Meier analysis.


RESULTS
A total of 173 patients (57%) had prior intervention on their aortic valve, 95 (31%) had isolated regurgitation, 91 (30%) had stenosis, and 119 (39%) had mixed pathology. There were 92 concomitant procedures (43 congenital lesions, 18 aorta, 9 mitral valve). In-hospital morbidity was 11.5% (35 of 305); mortality was 3.6% (11 of 305) and highest in infants. Need for an emergency operation (p < 0.05) predicted mortality in infants. The LVOT reintervention rate was lowest in infants compared with older patients (p < 0.05); conversely, age was directly related to RVOT reintervention (p < 0.01). Autograft encasement in a Hemashield (Atrium, Hudson, NH) tube in patients aged older than 10 years improved 5-year freedom from reintervention on the LVOT from 81% to 91% (p < 0.001). At last follow-up, aortic insufficiency was mild or less in 290 (95%) patients, and heart function was normal in 285 (93%).


CONCLUSIONS
The Ross procedure is a safe, effective, and anti-coagulation-free alternative for aortic valve replacement across all age groups. Long-term survival and preservation of heart function are highly favorable. Surgical mortality is related to salvage procedures in infants. When feasible, autograft durability can be improved by using a Hemashield graft for support.
Division of Cardiac Surgery, Department of Surgery, University of Southern California, Los Angeles, California.
Neeraj
N
Bansal
Division of Cardiac Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
S Ram
SR
Kumar
Division of Cardiac Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
Craig J
CJ
Baker
Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
Ruth
R
Lemus
Division of Cardiac Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
Winfield J
WJ
Wells
Division of Cardiac Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California. Electronic address: vaughn.starnes@med.usc.edu.
Vaughn A
VA
Starnes
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D002140:California / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000151:congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult