The Ross Procedure: Shorter Hospital Stay, Decreased Morbidity, and Cost Effective

Abstract

Background. The Ross procedure has become an accepted and sometimes preferred alternative to mechanical aortic valve replacement. One criticism of the Ross procedure is that it may have a higher operative mortality, morbidity, and cost. Several groups have shown that this operation can be performed safely with less than 3% mortality. The issue of higher cost has not been resolved. In this retrospective study we compared a consecutive group of patients undergoing the Ross procedure with an age- and disease-matched group of patients who underwent mechanical aortic valve replacement. Methods. From 1993 to 1996, 22 consecutive adult patients (age range, 20 to 57 years; mean, 38 ± 14 years) underwent the Ross procedure. Twenty-seven patients (age range, 17 to 57 years; mean, 41 ± 10 years) underwent mechanical aortic valve replacement between 1991 and 1996. The hospital cost (in 1996 dollars) and postoperative length of stay were calculated for each patient using Transition I, a hospital-wide cost accounting system. Results. There was no hospital mortality in either group. The incidence of significant valve-related complication was 5% (1/22 patients) in the Ross procedure group and 22% (6/27 patients) in the mechanical valve group. There were two late deaths in the group with mechanical aortic valve replacement. The length of stay for the Ross procedure group was 5.9 ± 2.1 days, versus 8 ± 1.85 days for the mechanical valve group ( p < 0.01). The mean hospital costs were not significantly different, $23,140 ± $7,825 for the mechanical valve group and $23,226 ± $6,960 for the group having the Ross procedure. Conclusions. The data from this review demonstrate that the Ross procedure can be done safely, with short hospital stays, decreased morbidity, and costs comparable with those of standard mechanical aortic valve replacement in patients with isolated aortic valve disease.