Outcomes of redo operations after the Ross procedure

Background: The Ross procedure is not commonly performed, owing to the pro-cedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedi-cated Ross center. Methods: We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019. Index and redo operation characteristics and outcomes were compared between patients with and those without redo op-erations. Multivariate analysis was used to identify independent predictors of Ross -related reinterventions. Survival was estimated with Kaplan-Meier analysis. Results: Sixty-six patients (29.3%) required redo Ross surgery, 41 patients (18.2%) underwent autograft reoperation only, 8 patients (3.6%) had a homograft reinter-vention, and 17 patients (7.6%) had both autograft and homograft reoperations (12 as a combined procedure and 5 as sequential procedures). The mean time to rein-tervention was 11 +/- 6 years for autograft reoperations and 12 +/- 7 years for homo-graft reoperations. Patients who underwent Ross-related reinterventions were younger (mean, 38 +/- 11 years vs 43 +/- 11 years; P < .01) and had a higher rate of New York Heart Association class III/IV (56% vs 38%; P = .02) at the index Ross procedure. Most patients undergoing autograft reintervention had aortic insuffi- ciency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft rein-tervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years was similar in patients who required a redo operation and those who did not (91.2% vs 93.9%; P = .23). Conclusions: Ross reinterventions can be performed safely and maintain patients at the normal life expectancy restored by the index Ross procedure up to 15 years at experienced centers.

Automated summary

This study examined the outcomes of patients who underwent Ross reinterventions at a dedicated Ross center. The results showed that patients who required reinterventions were younger and had higher New York Heart Association class at the initial procedure. The main reasons for reintervention were autograft insufficiency or aneurysm. The survival rate of patients who required reintervention was similar to those who did not.