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Contemporary Ross procedure outcomes: Medium-to long-term results in 214 patients

Lookup NU author(s): Dr Katrijn Jansen, Fabrizio De Rita, Dr Tony Hermuzi, Dr David Crossland, Dr John O'Sullivan, Dr Louise CoatsORCiD, Mohamed Nassar


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© 2021 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.†OBJECTIVE: Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate. METHODS: We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997-2009) and era 2 (2010-2019). RESULTS: Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15-38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148-202) and 202 (IQR 182-244) min. The median postoperative stay was 6 days (2-77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9-13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5-17.4) and 4.8 (IQR 2.5-7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation. CONCLUSIONS: The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.

Publication metadata

Author(s): Generali T, Jansen K, Steedman R, De Rita F, Vigano G, McParlin D, Hermuzi A, Crossland D, O'Sullivan J, Coats L, Hasan A, Nassar MS

Publication type: Review

Publication status: Published

Journal: European Journal of Cardio-thoracic Surgery

Year: 2021

Volume: 60

Issue: 5

Pages: 1112-1121

Online publication date: 09/05/2021

Acceptance date: 22/02/2021

ISSN (print): 1010-7940

ISSN (electronic): 1873-734X

Publisher: European Association for Cardio-Thoracic Surgery


DOI: 10.1093/ejcts/ezab193

PubMed id: 33969415