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Is It Reasonable To Offer The Ross Procedure To Patients Aged 50 And Older?
Claudia Oeser, Keziban Uyanik-Uenal, Alfred Kocher, Guenther Laufer, Martin Andreas.
Medical University of Vienna, Vienna, Austria.

OBJECTIVE: The Ross procedure provides several benefits. However, the risks associated with the complexity of this double-valve surgery are the reason why the 2020 American College of Cardiology/American Heart Association guideline limits its recommendation for the Ross procedure to patients < 50 years of age. This study evaluated the outcomes of patients who underwent the Ross procedure at the age of ≥ 50 years. METHODS: From January 1991 to July 2020, 128 patients between 18 and 35 years of age (group 1), 126 patients between 36 and 49 years of age (group 2), and 39 patients between 50 and 61 years of age (group 3) underwent the Ross procedure at a single center. In-hospital and long-term outcomes were compared between the groups. RESULTS: In-hospital mortality was not significantly different between the groups (group 1: 0.8%, group 2: 1.6%, group 3: 2.6%; P = 0.373). With regard to in-hospital complications, no significant relation existed between the groups and the need for re-exploration and low-cardiac output syndrome requiring mechanical circulatory support (group 1: 3.9%, group 2: 7.1%, group 3: 10.3%; P = 0.253). In contrast to patients aged between 18 and 35 and patients aged between 36 and 49, the overall survival of patients ≥ 50 years (observed) was comparable with the age- and sex-matched general population (expected) (Figure 1A). Freedom from surgical or percutaneous catheter-based Ross-related reintervention did not significantly differ between the groups (Figure 1B). CONCLUSIONS: At a highly experienced center, it is reasonable to offer the Ross procedure to patients ≥ 50 years of age.


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