Abstract
BACKGROUND: Excellent results for the Ross procedure have been demonstrated in selected, single-center series. Outcomes for higher-risk patients, including those with prior aortic valve intervention, are not well described, however. METHODS: This multicenter, retrospective analysis of adult recipients of the Ross procedure between 1994 and 2025 at 4 high-volume aortic centers compared patients with prior surgical aortic valve intervention (SAVI) and those with no prior aortic valve intervention. The primary outcome was operative mortality. Secondary outcomes included perioperative outcomes, longitudinal mortality, and reintervention. RESULTS: The study cohort comprised 594 patients, including 29 with prior SAVI and 565 without prior SAVI. The median age at surgery was 38 years (interquartile range [IQR], 32-48 years) for the SAVI group and 42 years (IQR, 32-51 years) for the non-SAVI group (P = .16). Racial distribution, body mass index, and male sex were comparable between the 2 groups. Rates of endocarditis were higher in the SAVI group compared to the non-SAVI group (treated: 6.9% vs 4.3%; active: 10.3% vs 1.4%; P = .012). There was 1 (3.5%) operative death in the SAVI group and 4 (0.7%) operative deaths the non-SAVI group (P = .22). Five-year Kaplan-Meier survival was higher in the non-SAVI group (log-rank P = .004), although no causes of death were cardiac in nature. CONCLUSIONS: Cardiac causes of death were absent in those with prior SAVI following the Ross procedure, suggesting that the Ross procedure can be safe in these patients when performed by skilled, experienced surgeons. Further studies are needed to more fully assess Ross procedure outcomes in patients with prior SAVI.