Implementing A Ross Program in A Low-Volume Center: Long-Term Outcomes Compared with Conventional Aortic Valve Replacement

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Introduction:The Ross procedure has demonstrated excellent long-term outcomes in young adults requiring Aortic Valve Replacement (AVR), but most data originate from high-volume centers.Whether comparable results can be achieved in lowervolume institutions remains uncertain. Methods:We conducted a retrospective single-center cohort study of 124 patients younger than 51 years who underwent elective aortic valve surgery between 2003 and 2020.The cohort comprised 43 patients who underwent the Ross procedure and 81 who underwent conventional AVR (mechanical or biological prosthesis).Primary endpoints were in-hospital mortality and morbidity.Secondary endpoints included late survival and valve-related events.Results: In-hospital mortality was 0% after the Ross procedure versus 2.4% (n = 2) after AVR (p = 0.54).Mean follow-up was 126 ± 66 months (Ross) and 128 ± 60 months (AVR).Late mortality was 9.3% in the Ross group (all non-cardiac-related deaths) versus 15.2% in the AVR group (primarily cardiac or valve-related causes).At 15 years, overall survival was 83.9% (Ross) versus 74.4% (AVR) (p = 0.54).Freedom from death and valve-related complications favored the Ross procedure (p = 0.054).After adjustment for age, dyslipidemia, left ventricular ejection fraction, and body mass index ≥30 kg/m², the Ross procedure independently predicted improved late survival and reduced valve-related morbidity (p = 0.041). Conclusion:In a structured program led by an experienced surgeon, the Ross procedure can be safely implemented in a low-volume center and is associated with excellent early outcomes and favorable long-term event-free survival compared with conventional AVR in selected young adults.

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