Abstract 19104: Impact of the Ross Procedure on Long Term Survival in Adults: A 25-year Single-center Follow-up Study

Abstract

Introduction: It has been accepted that early and mid-term survival of patients who underwent the Ross procedure is comparable to that of the general population. We reviewed our 25-year experience with the Ross procedure with the aim of defining long-term survival rates and freedom from reintervention. Hypothesis: We assessed the hypothesis that long-term survival following the Ross procedure was comparable to the general population when matched on age and gender. Methods: Between 1990 and 2015, the Ross procedure was performed on 310 consecutive adult patients in a single center. All patients were prospectively added in a dedicated cardiac surgery registry and every patient was included in the analysis. Complete postoperative clinical examination and history were obtained and transthoracic echocardiogram was performed according to a standardized protocol or when clinically indicated. There was no loss to follow-up. Median follow-up duration was 12.4 years and ranged up to 25 years. Approximately 58% of the study population was followed for more than 10 years. Results: The mean age of our cohort was 40.3 years and included 187 (60.3%) male patients. Congenital aortic valve disease was diagnosed in 77.1%. Indications for surgery were aortic stenosis in 64.6%, aortic insufficiency in 23.4% and mixed aortic disease in 12%. There were 4 (1.3%) hospital deaths and 26 (8.4%) late deaths. Survival at 10 and 25 years was 92.5% and 79.7% respectively. Freedom from pulmonary autograft reintervention was 97.5% and 48% at 10 and 25 years. Freedom from homograft-related reoperation was 99.1% and 69.9% at 10 and 25 years. Ross-related reoperation did not reduce long-term survival in our study population. However, compared to the general population, survival rate was significantly lower in patients following the Ross procedure when matched on age and gender. Conclusions: In conclusion, the Ross procedure is associated with excellent long-term survival, regardless of the need for surgical reintervention. However, long-term survival rates are lower in these patients when compared to matched individuals.