175. Survival and Reinterventions After the Ross Procedure in Adults: A 28 Year Follow-Up Study

Objective: To evaluate the long-term clinical outcomes of adult patients randomly assigned to undergoing a Ross procedure for the treatment of aortic valve disease.
Methods: From 1994 to 2001, 216 adults requiring aortic valve surgery were randomly assigned to undergo a Ross procedure or homograft aortic root replacement in a single center in the UK. Long-term outcomes after the Ross procedure were investigated. The primary endpoint was long-term survival, which was compared to the age-, origin- and sex-matched general population by a novel patient-level matching strategy. Secondary outcomes were freedom from any valve-related reintervention, autograft reintervention and allograft reintervention, and functional status at last follow-up using the NYHA classification. Median duration of clinical follow-up was 24.1 years (IQR 22.6-26.1 years; 2488 patient-years) and was 98% complete.
Results: After randomization, 108 adult patients (15% female) with a median age of 37.7 years (IQR 29.0-48.0 years) underwent a Ross procedure using a freestanding root technique. Of those, 8% had active endocarditis (n=9) and 42% were reoperations (n=45). The main lesion was aortic stenosis in 28% (n=30) and aortic regurgitation in 45% (n=49). There was one perioperative death (<1%). A total of 16 patients died during the study period. Actuarial survival at 25 years was 83.0% (95%CI, 75.5-91.2%), representing a relative survival of 99.1% (95%CI: 91.8-100%) compared to the matched general population (survival in general population:83.7%). At 25 years, actuarial freedom from any reintervention was 71.1% (95%CI: 61.6-82.0%), freedom from autograft reintervention was 80.3% (95%CI: 71.9-89.6%) and freedom from allograft reintervention was 86.3% (95%CI: 79.0-94.3%). At a median last follow-up of 24.6 years (IQR 23.2-26.2) among 93 patients, 80 patients (86%) were in NYHA class I or II.
Conclusions: In young adults with aortic valve disease, the Ross procedure provides excellent survival into the 3rd decade after the operation, which is equivalent to the matched general population. Additionally, long-term freedom from reintervention demonstrates that the Ross procedure is a durable aortic valve substitute into late adulthood, showing a delayed but progressive rate of degeneration. These data further confirm the unique benefits of a living valve substitute and support the need for a reevaluation of current guidelines for the treatment of aortic valve disease in young adults.

Giovanni Melina (1), Maximiliaan Notenboom (2), Kevin Veen (2), Fabio De Robertis (3), Paolo de Siena (3), Emiliano Navarra (1), Michael Ibrahim (4), Jullien Gaer (3), Ismail El-Hamamsy (5), Johanna Takkenberg (2), Magdi Yacoub (6), (1) Cardiac Surgery Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy, (2) Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands, (3) Cardiac Surgery Unit, Harefield Hospital, London, United Kingdom, (4) Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, (5) Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, (6) Imperial College and Aswan Heart Center, London (United Kingdom) and Aswan (Egypt)

Tirone David

Invited Discussant

 

Doctor Tirone E. David is a Professor of Surgery at the University of Toronto and the holder of the Melanie Munk Chair of Cardiovascular Surgery at the Peter Munk Cardiac Centre. Doctor David has published more than 400 scientific papers, 38 chapters in medical textbooks as well as 5 surgical textbooks.  He has developed numerous operative procedures to treat patients with heart valve disease, complications of myocardial infarction, and thoracic aneurysms and prospectively followed these patients during the past 4 decades. One of these procedures is known as “David operation”. He has been a member of the editorial board of several medical journals. Doctor David is active member of numerous surgical and medical societies and is honorary member of 14 international medical societies. He was President of the American Association for Thoracic Surgery in 2004-2005 and the recipient of its Scientific Achievement Award in 2016, and Lifetime Achievement Award in 2020. He was awarded the Order of Rio Branco from the Brazilian Government in 2018.  He received the Order of Ontario in 1993 and the Order of Canada in 1996, the highest honor given to civilians in Canada. He was elected University Professor in 2004, the highest honor the University of Toronto bestows to its professors.

Giovanni Melina

Abstract Presenter

Born and raised in Rome, Italy.
MD (1994) and Cardiac Surgery Resident (1994-1999), Sapienza University of Rome. PhD, Sapienza University of Rome (2004). Clinical Research Fellow, NHLI, Imperial College, London, UK (1999-2003). Staff Surgeon, Cardiac Surgery Unit Careggi Hospital, Florence, Italy (2003-2005). Since 2005, Cardiac Surgery Unit Staff Surgeon, Sant'Andrea Hospital, Rome. Senior Clinical Fellow Royal Brompton Hospital, London, UK (2009-2010). Appointed Associate Professor, Sapienza University of Rome in 2020, Full Professor since April 2022. Promoted to chair of the Cardiac Surgery Unit of Sant'Andrea Hospital in August 2022.

Specialties: Adult Cardiac, Aortic Valve, Pulmonary Valve, Anatomy and Conditions, Great Vessels, Aortic root, Valve, Aortic Valve, Pulmonary Valve, Treatment/Procedure/Operation/Surgery, Valve, Aortic valve, Pulmonary valve