The optimal prosthesis option for aortic valve replacement in adult patients <60 years of age with severe aortic stenosis (AS) remains controversial. The objective was to determine the long-term outcomes of the Ross procedure in this population.METHODS
Between 1990 and 2013, 276 patients aged 18 years and above (mean 40.3 ± 10.6) underwent an elective Ross procedure. Among them, 221 patients had predominant severe AS; these patients form the study group. The Ross procedure was performed either by aortic root replacement (n = 190; 86%) or the subcoronary technique (n = 31; 14%). There were 169 patients with bicuspid valves and 33 redo operations including previous aortic valve repair (n = 6) and replacement (n = 9) for severe AS. Demographic, preoperative, postoperative and longitudinal clinical and echocardiographic data were collected prospectively. The median and mean follow-up were 11.4 years (range: 1–20.1 years) and 10.1 ± 5.9 years, respectively. The follow-up was complete in all patients. Kaplan–Meier actuarial survival analysis was performed to assess long-term survival, freedom from reoperation for autograft and/or homograft failure and freedom from autograft valve insufficiency. Cox regression risk analysis was performed to identify factors associated with autograft or homograft reoperations.RESULTS
The perioperative mortality rate was 0.9% (n = 2). The incidence rate of early reoperation for bleeding was 5.9%. The actuarial survival rate at 10 and 15 years following surgery was 92.1 and 90.5%, respectively. Ross-related reoperations occurred in 21 patients during follow-up: autograft dysfunction (n = 9), homograft dysfunction (n = 6) and both (n = 6). The rate of freedom from Ross-related reoperation was 94.7 and 87.7% at 10 and 15 years, respectively. The rate of freedom from reoperation for autograft failure was 97.6 and 91.5%, the rate of freedom from reoperation for homograft failure was 95.7 and 90.8%, and the rate of freedom from moderate or severe autograft regurgitation was 94.1 and 85.6% at 10 and 15 years, respectively.CONCLUSIONS
Compared with available aortic bioprosthetic alternatives in young adults with severe AS, the Ross procedure provides an excellent long-term option for patients with predominant severe AS who seek a durable operation without anticoagulation.