The outcomes of the inclusion Ross in select patients ≥ 50, compared to a younger cohort.

Abstract

BACKGROUND\nThe Ross procedure is rarely considered in older patients. The aim of this study is to compare the perioperative and long-term outcomes of patients >50 years of age with younger patients after the Ross Procedure.\n\n\nMETHODS\nBetween 1992 and 2018, 455 patients underwent the Ross procedure utilizing the inclusion technique. Patients with redo-surgery, non-aortic procedures and unsupported root replacement were excluded. The remaining were matched for native valve morphology, valve lesion and annular manipulation and yielded 96 matched pairs. Preoperative and operative characteristics, perioperative outcomes, survival rates, valve related adverse events and valve hemodynamics were assessed.\n\n\nRESULTS\nThere was no in hospital mortality. The median follow up was 11 years for both cohorts. Over-all survival at 15 years was similar: 99% (95% CI 89.8%-99.8%) for patients >50 and 98% (95% CI 89.3-99.7%) for younger patients. Patients >50 had a notable freedom from ross related re-intervention at 15 years: 94% (95% CI 84.8-97.7%) vs. 90% (95% CI 80.2-95.6%) in younger patients. The mixed model analysis revealed being fifty and older was not significantly associated with higher autograft gradient or regurgitation. Interestingly, being fifty and older correlated with decreased allograft regurgitation and stenosis.\n\n\nCONCLUSIONS\nOlder patients undergoing the Ross procedure had comparable outcomes to younger patients. Patients fifty and over, that are high functioning with minimal comorbidities, should be considered for the Ross procedure.