The Ross procedure in patients older than 50: A sensible proposition?

Background: 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.

Methods: 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.

Results: Patients age >50 years had more comorbidities: diabetes (14% vs 4%; P < .01), chronic obstructive pulmonary disease (8% vs 2%; P < .01), and coronary artery disease (17% vs 3%; P < .01). In contrast, patients age ≤50 years had more redo surgeries (24% vs 8%; P < .01), pure aortic regurgitation (21% vs 6%; P < .01) and unicuspid valves (42% vs 9%; P < .01). In-hospital mortality was similar in the 2 groups (0.4% vs 0.4%; P = .99). There were no between-group differences in perioperative complications. The cumulative incidence of reintervention was similar at 6 years (>50 years: 0.7 ± 0.7%; ≤50 years: 4 ± 2%; P = .12). Survival at 6 years was 98 ± 2% in patient age >50 years versus 96 ± 2% in those age ≤50 years (P = .43), similar to the age- and sex-matched general population.

Conclusions: The Ross procedure is a safe operation in patients age >50 years and provides excellent hemodynamics, stable valve function, and restored survival at mid-term follow-up. In expert centers, it should be considered as an alternative in selected patients age >50 years.