Long-Term Outcomes of Patients Undergoing the Ross Procedure

Anas Aboud*, Efstratios I. Charitos, Buntaro Fujita, Ulrich Stierle, Jan Christian Reil, Vladimir Voth, Markus Liebrich, Martin Andreas, Tomas Holubec, Constanze Bening, Marc Albert, Petr Nemec, Jiri Ondrasek, Peter Murin, Rüdiger Lange, Hermann Reichenspurner, Ulrich Franke, Armin Gorski, Anton Moritz, Günther LauferWolfgang Hemmer, Hans Hinrich Sievers, Stephan Ensminger

*Corresponding author for this work
6 Citations (Scopus)


Background: Treatment of aortic-valve disease in young patients still poses challenges. The Ross procedure offers several potential advantages that may translate to improved long-term outcomes. Objectives: This study reports long-term outcomes after the Ross procedure. Methods: Adult patients who were included in the Ross Registry between 1988 and 2018 were analyzed. Endpoints were overall survival, reintervention, and major adverse events at maximum follow-up. Multivariable regression analyses were performed to identify risk factors for survival and the need of Ross-related reintervention. Results: There were 2,444 adult patients with a mean age of 44.1 ± 11.7 years identified. Early mortality was 1.0%. Estimated survival after 25 years was 75.8% and did not statistically differ from the general population (p = 0.189). The risk for autograft reintervention was 0.69% per patient-year and 0.62% per patient-year for right-ventricular outflow tract (RVOT) reintervention. Larger aortic annulus diameter (hazard ratio [HR]: 1.12/mm; 95% confidence interval [CI]: 1.05 to 1.19/mm; p < 0.001) and pre-operative presence of pure aortic insufficiency (HR: 1.74; 95% CI: 1.13 to 2.68; p = 0.01) were independent predictors for autograft reintervention, whereas the use of a biological valve (HR: 8.09; 95% CI: 5.01 to 13.08; p < 0.001) and patient age (HR: 0.97 per year; 95% CI: 0.96 to 0.99; p = 0.001) were independent predictors for RVOT reintervention. Major bleeding, valve thrombosis, permanent stroke, and endocarditis occurred with an incidence of 0.15% per patient-year, 0.07% per patient-year, 0.13%, and 0.36% per patient-year, respectively. Conclusions: The Ross procedure provides excellent survival over a follow-up period of up to 25 years. The rates of reintervention, anticoagulation-related morbidity, and endocarditis were very low. This procedure should therefore be considered as a very suitable treatment option in young patients suffering from aortic-valve disease. (Long-Term Follow-up After the Autograft Aortic Valve Procedure [Ross Operation]; NCT00708409)

Original languageEnglish
JournalJournal of the American College of Cardiology
Issue number11
Pages (from-to)1412-1422
Number of pages11
Publication statusPublished - 23.03.2021


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