The Ross Operation in Young Patients—a Single-Center, Long-Term Follow-Up Study.

Background: The standard aortic valve replacement operations in young patients are bioprosthetic or mechanical aortic valve replacement. In this study, we present the long-term results of the Ross operation in young patients.

Methods: The Ross operation with root replacement was performed on 795 patients between 1995 and 2020. The endpoints were overall survival, re-operation/reintervention rates on the autograft and homograft/RV-PA conduit (RV, right ventricle; PA, pulmonary artery), and the occurrence of serious adverse events.

Results: 795 patients (75% male, 25% female; mean age 43 ± 14 years) underwent the Ross operation with root replacement. The 30-day mortality was 1% (8 patients) with a 95% confidence interval of [0.48; 1.9]. The follow-up was 96 % complete and covered 9540 patient-years, with a mean follow-up time of 12 ± 7 years. The survival rates at 5, 10, 15 and 20 years were 97% [96; 98], 96% [93; 96], 92% [89; 94] and 86% [83; 90]. The rate of autograft survival without reoperation was 94% [92; 96] at 10 years and 80% [76; 85] at 20 years. The rate of homograft/RV-PA conduit survival without reoperation was 95% [93; 97] at 10 years and 85% [81; 90] at 20 years. There were 5 cases of hemorrhage, 14 of thromboembolic complications or apoplexy, and 19 of endocarditis.

Conclusion: The Ross operation with root replacement was associated with high survival rates over 25 years of follow-up. The rates of reoperation and reintervention, the morbidity and mortality, and the rate of endocarditis are low. The Ross operation is thus an effective surgical treatment option for young patients with aortic valve disease.