A Single Center 25 Year Experience With The Ross Procedure In Over 200 Congenital Cardiac Patients
Damien LaPar1, Philip Allen1, Morgan Moroi1, Stephanie Nguyen1, Stephanie Levasseur1, Matthew Lewis1, Marlon Rosenbaum, MD1, Harsimran Singh2, Jonathan Ginns2, David Kalfa1, Emile Bacha1
1Columbia University College of Physicians and Surgeons, New York, NY, USA, 2Weill Cornell College of Medicine, New York, NY, USA
Objectives: The Ross procedure remains the gold standard for aortic valve dysfunction but with evolving techniques (e.g. Ozaki) and transcatheter technology, defining long-term outcomes for the Ross procedure remains critical for comparison.
Methods: Patients undergoing the Ross from 1993-2018 at a single institution for severe aortic valve dysfunction were stratified into age categories: < 1y, 14%, 1-10y, 26%, 11-17y, 27% and >18y, 33%. Univariate and Kaplan-Meier evaluated operative and long-term outcomes. Results: 201 patients underwent the Ross (73%) +/- Konno (27%) procedure. Mean age was 16±14y with follow-up 5±7y. Isolated aortic insufficiency (45%) was the most common indication, while isolated stenosis (52%) was most common in infants. A pulmonary homograft RV-PA conduit was utilized for 89% of RVOT reconstructions. Overall mortality was 1.5% and highest among infants (Age I: 7%). Importantly, Kaplan-Meier long-term survival was high across age groups (< 93% for all). Freedom from autograft and RVOT reinterventions were lowest for infants, with strong durability to 15 years in older cohorts. Importantly, moderate-severe neo-aortic insufficiency after Ross was 11% and not associated with valve pathology (P=0.25).
Conclusions: Long-term results for the Ross remain promising with excellent survival and durability of the neo-aortic autograft. Neonates and infants remain the highest risk cohort with the earliest need for RVOT re-intervention. These long-term data provide critical benchmarks to which future surgical and catheter-based therapy should be compared.
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