An alternative to AVR: Ross procedure linked to strong outcomes for young, middle-aged adults

The Ross procedure is associated with consistently positive outcomes for young and middle-aged adults, according to a new analysis published in in JAMA Cardiology.

“Despite excellent results, the Ross procedure remains an underused treatment, limited to experienced centers and surgeons,” wrote first author Jamie L. R. Romeo, MD, PhD, a specialist at Erasmus Medical Center in the Netherlands, and colleagues. “Its limited use is often attributed to the complexity of the procedure and concerns about increased risks of early mortality and late reintervention.”

Romeo et al. noted that recent valvular heart disease guidelines have not recommended the Ross procedure for middle-aged patients. However, they added, evidence has continued to build that suggests the procedure is an effective surgical alternative to aortic valve replacement (AVR).

To learn more, the researchers tracked data from more than 1,400 patients who underwent the Ross procedure at one of five high-volume facilities from 1991 to 2018. All patients were between the ages of 18 and 65 years old.

Overall, the Ross procedure achieved survival rates of 95.1% after 10 years and 88.5% after 15 years. In-hospital mortality was just 0.7%, and even after a median follow-up period of more than nine years, there were just 37 reports of stroke and 14 reports of autograft endocarditis.

Romeo and colleagues also examined post-procedure echocardiographic findings, noting that the results showed signs of “excellent” valve function.

“This international multicenter cohort study of consecutive young and middle-aged adults undergoing the Ross procedure shows excellent survival and outstanding clinical and echocardiographic outcomes,” the authors wrote, noting that improved access to the procedure is still essential.

“The Ross procedure should be considered in young and middle-aged adults who need AVR and can be referred to dedicated centers with expertise in this operation,” the team concluded.

Click here for the full study from JAMA Cardiology.