"Ross procedure"

Long-Term Clinical Outcomes and Health-Related Quality of Life After the Ross Procedure. To evaluate long-term clinical outcomes and health-related quality of life (HR-QoL) in young adults following Ross procedures for aortic valve pathology. From January 1990 to April 2021, 166 patients aged 14 to 63 years underwent the Ross procedure at Cleveland Clinic. Outcomes included postoperative events PROMIS or MacNew scores. The Ross procedure results in favorable long-term outcomes including survival, autograft function and enhanced HR-QoL in young adults with aortic valve pathology. Despite low mortality and stable valve function, reinterventions, especially among the socioeconomically disadvantaged, pose concerns.

Ross procedure: valve function, clinical outcomes and predictors after 25 years' follow-up. To describe long-term outcomes of the Ross procedure in a single center and retrospective series after 25 years follow-up. From 1997-2019 we included all consecutive patients who underwent Ross procedure at our center. Clinical and echocardiographic evaluations were performed at least yearly . Echocardiographic valvular impairment was defined as at least moderate autograft or homograft dysfunction. Reintervention outcomes included surgical and percutaneous approach. 151 Ross procedures were performed (mean age 28±12years, 21%<16years, 70%male). After 25 years follow-up (median 18 years, interquartile range 9-21, only 3 patients lost) 12 patients died (8%); Autograft, homograft or any valve dysfunction

Long-Term Autograft Dilation and Durability After the Ross Procedure are Similar Among Infants, Children, and Adolescents with Primary Aortic Stenosis. Autograft durability and remodeling are thought to be superior in younger pediatric patients after the Ross operation. We sought to delineate the fate of the autograft across the pediatric age spectrum in patients with primary aortic stenosis

Aortic insufficiency following balloon aortic valvuloplasty does not impact long-term autograft durability after the Ross procedure. Preoperative aortic insufficiency (AI) is associated with inferior autograft durability after the Ross procedure. However, many patients with aortic stenosis (AS) undergo balloon aortic valvuloplasty (BAV) early and present with longstanding AI before Ross. We was 90%, 92%, and 62% in BAV, AS, and AI groups, respectively. The AI group was at significantly increased risk of long-term autograft failure (HR 5.6, p=0.01), while AS and BAV groups had similar, low risk (HR 1.1, p=0.91). Autograft durability was similar among BAV patients who presented with AS or AI before the Ross (p=0.84). BAV prior to the Ross procedure is common in patients

Long-Term Results of Patients Undergoing a Ross Procedure After a Previous Aortic Valve Surgery. To assess the long-term outcomes of patients undergoing a Ross procedure in the context of a redo aortic valve surgery. Prospectively collected data in all consecutive adults who underwent a Ross procedure were analyzed to compare the Ross procedure as a first surgery (RF) and as a redo (RP) surgery . Between 1990 and 2021, 395 Ross procedure were performed at our center (RF 345 and RP 50). A 2:1 propensity-match was performed (100 in RF group and 50 in RP group). The overall median follow-up is 11.6 [IQR 5.0-21.8] years and 100% complete. Survival was 87±12% in the RF group and 87±8% in the RP group at 20 years (p=0.30). The cumulative incidence of autograft reintervention was 6±3% and 21±6

Long-Term Outcomes Following the Ross Procedure in Neonates and Infants: A Multi-Institutional Analysis. For neonates and infants with aortic valve pathology, the Ross procedure has historically been associated with high rates of morbidity and mortality. Data regarding long-term durability are lacking. The international, multi-institutional Ross Collaborative included six tertiary-care centers

The Landscape of Congenital Heart Disease Treated with the Ross Procedure. The Ross procedure has excellent outcomes in the pediatric population. Some series report age and anatomy dependent outcomes, but no comprehensive analysis stratified by these variables exists. We sought to describe the landscape of congenital heart disease (CHD) treated with the Ross procedure and identify the patients best served with this operation. Over 30 years, 317 pediatric patients underwent the Ross procedure. Patients were stratified into 4 age groups: neonates (<31days,n=21), infants (31days-1year,n=40), children (1-12years,n=165), and adolescents (13-18years,n=91), and 3 anatomical groups: isolated aortic valve (AV) disease (n=221), Shone's complex or multilevel LVOT obstruction (n=61), and complex CHD

Durability of Right Ventricular Conduits in the Ross Procedure. Right ventricular (RV) conduit availability and degeneration are potential limitations of the Ross procedure. Pulmonary homografts are the gold standard but their limited availability drives the need for alternatives. The aim of this study was to compare results of different RV conduits. Between 1995 and 2023, 315 consecutive patients (mean age:37±12years, 73% male) underwent a Ross procedure using a homograft (n=211), bovine jugular vein ('BJV') (n=34) or xenograft (n=70) as RV conduit. Mean follow-up was 5.7±6.7years and was 96% complete (1631 patient-years). Twelve patients (homograft 8/211, BJV 3/34, xenograft 1/70) required RV conduit reintervention, four patients (homograft) within 4 years. Indications

Pulmonary Homograft vs Handmade Polytetrafluoroethylene-valved Conduits after The Ross procedure. We aim to longitudinally compare expanded-polytetrafluoroethylene (ePTFE) valved vs pulmonary homograft (PH) conduits after right ventricular outflow tract reconstruction in the Ross procedure. We identified patients undergoing a Ross procedure from June 2004 to December 2021. Echocardiographic data ). The overall surgical conduit replacement was 15% (n=14), being higher in the homograft group (30% vs 8%; p=0.008). However, conduit type was not associated with increased hazard for reintervention or reoperation after adjusting for covariates. RVOT reconstruction using handmade ePTFE-valvedconduits after a Ross procedure provides encouraging midterm results, without a differential effect in hemodynamic

Outcomes of redo operations after the Ross procedure. The Ross procedure is not commonly performed, owing to the procedural complexity and the risk of autograft and/or homograft reoperation. This study examined outcomes of patients undergoing Ross reinterventions at a dedicated Ross center. We retrospectively reviewed 225 consecutive patients who underwent a Ross procedure between 1994 and 2019 ) 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 insufficiency and/or aneurysm (98.2%; 57 of 58). The primary reason for homograft reintervention was pulmonary stenosis (92%; 23 of 25). The operative mortality of Ross reintervention was 1.5% (1 of 66). Survival at 15 years

Unicuspid Aortic Valve in Patients Undergoing the Ross Procedure. The prevalence and outcomes of the unicuspid aortic valve (UAV) in patients undergoing the Ross procedure have been strongly underreported in the current literature. We sought to evaluate this in comparison with bicuspid (BAV) and tricuspid valve (TAV) in our Ross cohort. This was a retrospective observational study of patients undergoing the Ross procedure at 2 dedicated centers between 2009 and 2020. Primary end points were the risks of midterm autograft reoperation and the onset of at least moderate aortic regurgitation during follow-up. The secondary end point was to compare the perioperative outcomes between the groups. Included in the analysis were 286 patients, of those 39% with UAV, 52% with BAV, and 9% with TAV. UAV

Valve-sparing root replacement after the Ross procedure. The Ross procedure is a preferred treatment for infants and children with aortic valve disease. Progressive neoaortic root dilation and neoaortic insufficiency can occur after the Ross procedure, and because of the young age of these patients, valve-sparing aortic root replacement procedures have advantages compared with the Bentall procedure. The aim of this study is to describe our experience with different techniques of aortic valve-sparing root replacement in this unique cohort of patients. Patients undergoing valve-sparing aortic root replacement with a history of the Ross procedure between January 2001 and March 2021 were identified. A retrospective chart review was performed, and clinical characteristics of these patients were

Ross procedure in neonates and infants: A valuable operation with defined limits. The Ross procedure is an important tool that offers autologous tissue repair for severe left ventricular outflow tract (LVOT) pathology. Previous reports show that risk of mortality is highest among neonates and infants. We analyzed our institutional experience within this patient cohort to identify factors . Ross procedure is effective in children less than one year of age with left sided obstructive disease isolated to the aortic valve and/or aortic arch. Patients less than 3 months of age with Shone or IAA/VSD are at higher risk for morbidity and mortality. Survivors experience excellent intermediate-term freedom from LVOT reintervention.

Aortic valve repair versus the Ross procedure in children. Aortic valve repair and Ross procedure (RP) are widely used in children; however, it is unclear which provides the best outcomes. Patients who underwent primary aortic valve surgery from 1980 to the 2018 were included. Propensity-score matching was performed to adjust for baseline differences. Of 415 children, 82.7% (343/415) underwent overall freedom from reoperation was similar. When an acceptable intraoperative result was achieved, outcomes of repair were favorable. However, when the intraoperative result of repair was suboptimal, the Ross procedure performed better.

Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure: A Post Hoc Analysis of a Randomized Clinical Trial. The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest. To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD. This post hoc analysis of a randomized clinical trial included adult patients (age <69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after

Ross Procedure in Children: The Society of Thoracic Surgeons Congenital Heart Surgery Database Analysis. Single-center studies have demonstrated excellent results for the Ross procedure in children. We aimed to evaluate national variation in clinical outcomes using The Society of Thoracic Surgeons Congenital Heart Surgery Database. The database was used to identify 2805 children undergoing the Ross procedure from 2000 through 2018, comprising 163 neonates (<30 days, 5.8%), 448 infants (30-365 days, 16.0%), 1444 children (1-12 years, 51.5%), and 750 teenagers (13-17 years, 26.7%). Centers were divided into terciles by procedural volume. Multivariable logistic regression was used to identify predictors of a composite outcome of operative mortality, neurologic deficit, or renal failure

Complexity and Outcome of Reoperations After the Ross Procedure in the Current Era. The Ross procedure has several advantages, but the need for reintervention is inevitable. The aim of this study was to examine the complexity and outcomes of reoperation after the Ross procedure. Retrospective chart review was performed of patients with a prior Ross procedure who underwent reoperation at our institution from September 1991 to January 2021. Demographic, echocardiographic, surgical, and perioperative data were collected. Descriptive statistical and regression analyses were performed. A total of 105 patients underwent a reoperation at Mayo Clinic after the initial Ross procedure performed at our institution (n = 16; 16.2%) or elsewhere (n = 83; 83.8%). Mean age at the Ross procedure was 27 ± 17

Impact of Preoperative Aortic Regurgitation on Long-term Autograft Durability and Dilatation in Children and Adolescents Undergoing the Ross Procedure. Primary aortic insufficiency (AI) is a risk factor for autograft reintervention in adults undergoing the Ross procedure. We sought to examine the impact of preoperative AI on autograft durability in children and adolescents. From 1993-2020, 125 consecutive patients between ages 1-18 underwent a Ross procedure. The autograft was implanted using a full-root technique in n=123 (98.4%) and included in a Dacron graft in n=2 (1.6%). Patients with aortic stenosis (AS group) (n=85) were retrospectively compared to those with AI or mixed disease (AI group) (n=40). Median length of follow-up was 8.2 (IQR 3.3-15.4) years. The primary endpoint

Long-term outcomes with the pulmonary autograft inclusion technique in adults with bicuspid aortic valves undergoing the Ross procedure. To compare outcomes with wrapped (pulmonary autograft inclusion) versus unwrapped techniques in adults with bicuspid aortic valves undergoing the Ross procedure. Between 1992 and 2019, 129 adults with bicuspid aortic valves (aged ≥18 years) underwent the Ross , 95% confidence interval, 0.08-0.91; P = .035). The cumulative incidence of autograft reintervention (death as a competing outcome) at 1, 5, and 10 years, respectively, was 10.2%, 14.9%, and 26.8% in the unwrapped cohort and 4.0%, 4.0%, and 4.0% in the wrapped cohort. In adults with bicuspid aortic valves, the Ross procedure with pulmonary autograft inclusion stabilizes the aortic root preventing

The Ross procedure in patients older than 50: A sensible proposition? The Ross procedure offers several advantages in nonelderly adults; however, the optimal age cutoff remains undetermined. The aim of this study was to compare the safety and mid-term outcomes after the Ross procedure in adult patients age ≤50 years and those age >50 years. Between 2011 and 2019, 497 consecutive patients (mean age, 47 ± 12 years; 73% male) underwent a Ross procedure in 5 Canadian centers and were followed prospectively. Of these patients, 232 (47%) were age >50 years (mean, 57 ± 4 years) and 265 (53%) were age ≤50 years (mean, 38 ± 10 years). Early and mid-term outcomes were compared between the 2 groups. Patients age >50 years had more comorbidities: diabetes (14% vs 4%; P < .01), chronic obstructive