A 22-year study of 252 patients who underwent the Ross procedure for aortic valve disease demonstrated a 90.3% survival rate at 20 years, with 87% of the patients remaining free from reintervention during the same period.
The findings, presented at the 2025 Society of Thoracic Surgeons (STS) Annual Meeting, represented one of the longest follow-up studies of the procedure from a single high-volume center.
Researchers, conducted at the Narayana Institute of Cardiac Sciences in Bengaluru, India, showed progressive survival rates of 95.8%, 94.3%, and 93.3% at 5, 10, and 15 years, respectively. Freedom from aortic regurgitation remained high throughout the follow-up period, with rates of 95.1%, 92.2%, 87.7%, and 84.5% at 5, 10, 15, and 20 years, respectively.
"The Ross operation can be performed safely, with results comparable to mechanical valve replacement," highlighted lead study author Varun Shetty, MBBS, DNB (CVTS), FRCS (CTS), of the Narayana Institite of Cardiac Sciences. "It has the added advantage of avoiding oral anticoagulation drugs and the risks associated with lifelong anticoagulation," he added.
The study included various surgical techniques: 186 of the patients underwent cylinder inclusion technique (mini root replacement), 25 of them received Dacron-reinforced autografts, and 3 of them underwent the Ross-Konno procedure. Additional procedures included ascending aorta replacement (n = 25), hemiarch replacement (n = 2), and septal myectomy (n = 4).
Freedom from pulmonary regurgitation showed a gradual decline over time: 97% at 5 years, 83.6% at 10 years, 79.7% at 15 years, and 75.1% at 20 years. The researchers identified specific risk factors for late autograft dysfunction, including dilated aortic annulus and ascending aorta. Notably, patients aged 18 years or younger showed higher rates of aortic regurgitation.
"The main drawback of the Ross operation is failure of the autograft over time," Dr. Shetty noted. "We wanted to examine our outcomes, and we were pleasantly surprised to find that the freedom from reintervention was 91% at 10 years and 87% at 20 years," he emphasized.
The findings were benchmarked against the STS Congenital Heart Surgery Database, which contains more than 600,000 procedure records. According to Dr. Shetty, most patients discontinued cardiac medications after the first postoperative year, and the procedure's use of living tissue eliminated the need for anticoagulation while allowing valve growth in pediatric patients.
"The most important message from our study is that the Ross procedure offers excellent long-term survival rates with low risk of reintervention even at 20 years," underscored Dr. Shetty. "This makes the Ross operation an excellent substitute for mechanical valve replacement," he concluded.