Outcomes of the Ross procedure in patients older versus younger than 50 years old

Abstract

Background The Ross procedure is traditionally considered for young adult patients with aortic valve disease. This study compares long-term outcomes of patients undergoing the Ross procedure who are ≥50 and <50-years old. Methods Data was collected from 225 patients undergoing Ross procedure at a single center from 1994 to 2019. Patients were categorized into younger (<50-years old; N = 156) and older (≥50-years old; N = 69) cohorts. Baseline demographics clinical outcomes were compared. Results The mean age was 36±8.1 and 55±4.2 in the younger and older cohort, respectively. Both groups were predominantly male (58.5% vs 69.6%; p = 0.59). The younger group had a higher rate of aortic insufficiency (51% vs 26.1%; p < 0.01), and bicuspid aortic valve (81.4% vs 58.0%; p < 0.01). Aortic stenosis was more prevalent in the older cohort (25.6% vs 58.0%; p < 0.01). Operative mortality was acceptable in both groups (1.3% vs 4.3%; p = 0.15). Survival up to ten years was not statistically different between two groups (96.2% vs 91.3% p = 0.16). Whereas survival up to fifteen years survival for younger patients was significantly higher (94.9% vs 85.5%; p = 0.03). After non-cardiac related deaths were excluded, survival up to fifteen years (98.7% vs 91.3%; p = 0.02) was significantly lower than younger patients. In both groups, survival after the Ross procedure was similar to the age and sex-matched US population. Conclusions Survival up to 10 years after Ross procedure were similar, but up to 15 years was significantly higher in younger patients. The Ross procedure restored patients from both groups to expected survival. Our results suggest that at experienced centers, the Ross procedure is a safe and reasonable option for patients who are 50 years and older.