Cleveland Clinic patients who received the Ross procedure for aortic valve replacement after 2000 have experienced better outcomes than patients who received the procedure prior to 2000, according to a 30-year longitudinal study published March 3 in the Annals of Thoracic Surgery.
“Many surgeons have shied away from the Ross procedure because of reports of complications during the 1990s and the potential need for reintervention for two valves,” Shinya Unai, MD, study author and cardiac surgeon at Cleveland Clinic, said in a June 16 news release from the health system. “However, improved surgical approach, patient selection and postoperative management over the years have made it a compelling option for AVR, especially for young adults.”
Here are five things to know from the study:
- In 2020, the American College of Cardiology and the American Heart Association gave the Ross procedure a class IIB or “weak” valve guideline recommendation “due to insufficient evidence,” the news release said.
- Beginning in 2000, the Cleveland Clinic implemented new patient selection standards — favoring patients under the age of 55 with “optimal” preoperative function and controlled hypertension — in addition to improving surgical techniques and follow-up protocols.
- For the 30-year study, Cleveland Clinic researchers analyzed the outcomes of 166 patients from January 1990 and April 2021. Of those patients, 73 underwent the Ross procedure before 2000 and 93 underwent the procedure after 2000.
The median patient follow-up was 7.3 years, with 25% of patients followed for more than 19 years and 10% of patients followed for more than 27 years. - Overall patient survival was 94% at 10 years after the Ross procedure and 70% at 25 years. No deaths occurred in patients who had undergone the procedure after 2000, and two patients experienced stroke about five years after the procedure.
- Among patients who underwent the Ross procedure after 2000, long-term autograft valve mean gradients remained low — at an average of 4.4 mm Hg after 20 years — and 10-year freedom from all reintervention was 96%.
Read the full study here.
