A 17-year, single-centre experience with the Ross procedure: fulfilling the promise of a durable option without anticoagulation?

Objectives: For adult patients <60 years with aortic valve disease, the Ross procedure is an attractive alternative to a prosthetic aortic valve. The Ross procedure enables surgeons to achieve a haemodynamically ideal aortic valve replacement. A potential drawback may be long-term durability, which varies considerably between series.

Methods: Between 1996 and 2014, 209 patients (mean age, 43 ± 10 years) underwent an elective Ross procedure in our department. In 78% (n = 161) of patients a bicuspid valve was found. Patients were examined clinically and with echocardiography during the follow-up. The mean follow-up was 7.9 ± 5 years and was 98% complete.

Results: The 30-day mortality rate was 2.4% (n = 5). The Kaplan-Meier survival rates at 10 and 15 years were 91 and 85%, respectively. In 17 patients (8.3%) the pulmonary autograft had to be reoperated on: 12 of them could be repaired; only 5 patients finally underwent prosthetic valve replacement. The rate of freedom from reoperation for autograft failure was 93% and that from reoperation or moderate autograft regurgitation was 87% at 10 years. Thromboembolic events occurred in 9 patients (0.54%/patient-year) and were mostly related to atrial fibrillation. Endocarditis involving the pulmonary autograft was observed in 6 patients (0.36%/patient-year).

Conclusions: Pulmonary autograft aortic root replacement to treat patients with severe aortic valve dysfunction is a challenging procedure. The reoperation rate is higher compared with mechanical valve replacement; however, in the majority of patients with reoperations in our series the autograft could be saved. Other valve-related complications are rare.