Ross Procedure Offers Excellent Long-Term Survival for Young Patients with Aortic Valve Disease

Recent research presented at the 61st annual meeting of The Society of Thoracic Surgeons (STS) highlights the remarkable success of the Ross procedure for aortic valve disease in young patients. This 22-year study reveals that the majority of these patients achieve excellent long-term survival, with minimal need for additional surgeries.

Key Findings: The Ross Procedure’s Superior Outcomes

The study, conducted at the Narayana Institute of Cardiac Sciences in Bengaluru, India, examined the outcomes of 252 patients who underwent the Ross procedure, a type of heart valve replacement surgery. Lead author and cardiac surgeon Dr. Varun Shetty reported that, at 20 years post-surgery, 87% of patients remained free of re-intervention.

“The Ross operation can be performed safely with results comparable to mechanical valve replacement,” Dr. Shetty stated. “It offers an additional advantage by eliminating the need for lifelong anticoagulation drugs and their associated risks. In many cases, patients are not on any cardiac medications one year after surgery.”

We were pleasantly surprised to find that the freedom from re-intervention was 91% at 10 years and 87% at 20 years.

Varun Shetty, Narayana Institute of Cardiac Sciences

Understanding the Ross Procedure

The Ross procedure involves replacing the malfunctioning aortic valve with the patient’s own healthy pulmonary valve, a technique known as an autograft. The pulmonary valve is then replaced with donor tissue. This procedure is particularly beneficial for younger patients because the valve can grow along with the patient.

“This autograft method provides long-term viability compared to a mechanical valve, which might need replacement due to wear and tear,” explained Dr. Shetty.

Addressing Potential Challenges

A major concern with the Ross procedure is the potential for autograft failure over time. However, the study shows that this can be minimized. Dr. Shetty’s study also observed a lower freedom from pulmonary regurgitation, which refers to blood flowing backward through the valve. The regurgitation rates were 97% at 5 years, dropping to 75.1% at 20 years.

“Individuals aged 18 years or younger exhibit notably higher rates of aortic regurgitation. Risk factors for late autograft dysfunction include a dilated aortic annulus and ascending aorta,” Dr. Shetty noted.

“Improvements in the stabilization of the aortic annulus and pulmonary autograft will likely improve the repeat intervention rate in the future,” he added.

Comparing to Mechanical Valves

The Ross procedure offers several advantages over mechanical valves, such as the absence of a need for long-term anticoagulation medications. This reduces the risk of bleeding and clotting issues associated with such drugs.

“The Ross procedure is an excellent substitute for mechanical valve replacement,” Dr. Shetty concluded. “Our study reveals that with proper techniques and follow-ups, the Ross procedure provides excellent long-term survival rates and reduced risk of re-intervention.”

International Applicability

Dr. Shetty’s team benchmarked their results against the Society of Thoracic Surgeons’ Congenital Heart Surgery Database (CHSD), which includes over 600,000 procedure records from around the world. This benchmarking highlights the global applicability of the Ross procedure.

“Our study, performed at a high-volume surgical center in India, demonstrates that the Ross operation can be performed with reproducible success across the globe,” Dr. Shetty stated.

The Future of Heart Valve Surgery

The Society of Thoracic Surgeons databases serve as vital resources for benchmarking clinical outcomes in cardiothoracic surgery. The CHSD, part of the STS National Database, offers insights from nearly 10 million procedures performed by over 4,300 surgeons.

With these vast amounts of data, we can continually improve surgical techniques and patient outcomes.

As heart valve surgery continues to advance, studies like these support the use of the Ross procedure, particularly in younger patients seeking long-term solutions.

Conclusion

This long-term study showcases the effectiveness and safety of the Ross procedure for young patients with aortic valve disease. The procedure not only ensures excellent long-term survival and rare re-intervention but also reduces the need for medications that often accompany mechanical valve replacements.

As more data becomes available, the Ross procedure is emerging as a preferred option, particularly for younger patients whose long-term cardiovascular health is paramount.

We encourage readers to share their thoughts on this groundbreaking research and how it could impact future treatments for aortic valve disease. Don’t hesitate to comment, subscribe, or share this article on social media to stay informed about the latest advancements in cardiac surgery.