Operative Risks of the Ross Procedure

ABSTRACT OBJECTIVES Risk of the Ross procedure continues to be debated. We sought to determine immediate outcomes of the Ross procedure in a large consecutive cohort that included patients having re-operative cardiac surgery and/or requiring concomitant cardiac procedures. METHODS From March 1987 through September 2019, 702 patients had a full root Ross procedure. There were 530 male and 172 female patients with mean age 41.6 years. 101 patients had at least one previous sternotomy. 323 patients had concomitant procedures. Patients were stratified into two groups, Simple and Complex. Simple Ross patients were those who had no previous sternotomy and had only minor concomitant procedures performed at the time of their Ross such as aortoplasty and closure of patent foramen ovale. The Complex Ross group included patients with at least one previous sternotomy, and/or additional procedures we deemed complex, such as ascending aortic replacement and mitral valve repair. Complexity and group outcomes were evaluated in consecutive terciles of time. RESULTS There were 7 (1%) operative deaths. Morbidity affected 46 other patients (6.6 %). Simple Ross totaled 419 patients (59.7 %) with mortality in 3 (0.7 %) and morbidity in 20 (4.8 %). Complex Ross totaled 283 (40.3 %) with mortality in 4 (1.4 %) and morbidity in 26 (9.2 %). Simple Ross cases decreased in volume over time, with complex cases increasing from 34% to 48%. CONCLUSIONS Excellent results can be achieved with the Ross procedure despite broader indications that include patients with previous sternotomy and with need for concomitant procedures.