Short-Term Outcomes of the Ross Procedure in Patients Greater and Less than 45 Years of Age

Background: There is no ideal aortic valve replacement. When compared to bioprosthetic and mechanical valves, a Ross procedure may offer significant advantages such as improved durability and restoration of normal life-expectancy. Whether such advantages are maintained in older patients is not well established. This study compares perioperative and medium-term outcomes of the Ross procedure in patients under the age of 45 and 45–65 years.

Methods: This study retrospectively reviewed 76 patients undergoing the Ross procedure between 2020 and 2023 at a single academic center. The patients were stratified into young (18–44, n = 47) and middle-aged groups (ages 45–65, n = 29). Perioperative and medium-term outcomes to 1 year are reported.

Results: The average age of the young group was 32 (± 6.5) years versus 54.1 (± 5.2) years in the older group (p < 0.001) with more comorbidities and bicuspid aortic valve disease in the older group and no difference in primary symptoms, NYHA class, or ventricular function between the groups. There were no significant differences in the operative details between the groups. Perioperative outcomes showed a higher rate of atrial fibrillation 34.5% (n = 10) versus 12.8% (n = 6), p < 0.05 and prolonged inotrope use (over 48 h) 20.7% (n = 6) versus 2.1% (n = 1), p < 0.05 for the older group. There were no in-hospital mortalities. Medium-term outcomes showed no differences in ventricular or valvular function between the groups. There was one postdischarge mortality in the entire cohort (2.13%). No patients required autograft reintervention.

Conclusions: The Ross procedure can be safely performed in selected patients 45–65 years of age with comparable perioperative and short-term outcomes to younger patients.