Ross Procedure Safe in Adults Despite Prior Cardiac Surgery, suggests study

The assessment of medium-term safety and durability of Ross procedure in reoperation conditions was performed by analyzing a group of 816 adult patients operated on at the Montreal Heart Institute between 2011 and 2025. Patients from the study population consisted of 83 patients (10.2%) who had their redo Ross operation done after at least one previous aortic valve surgery and 733 patients (89.8%) who underwent primary Ross procedure.

Propensity-score overlap weighting made adjustment for 9 covariates that were chosen a priori: age, gender, NYHA classification, left ventricular ejection fraction, bicuspid aortic valve morphology, pure aortic stenosis, pure aortic regurgitation, active endocarditis, and preoperative aortic regurgitation grade.

The long-term survival rate was assessed by using overlap-weighted Kaplan-Meier analysis over a median follow-up period of 5.0 years (IQR 1.6–8.4), the reintervention rates were modeled by using Aalen-Johansen competing risk model, aortic root dilation – by the longitudinal echocardiographic weighted generalized estimating equations approach.

Key findings:

• Quantitative differences in the outcomes and longitudinal root dimensions were found during the comparative analysis among the 816 propensity-weighted adult patients.
• Mortality at the time of surgery was 2.4% in the redo Ross group versus 0.3% in the primary Ross group (P = 0.054).
• All-cause mortality after propensity overlap weighting within 5.0 years of follow-up was found to be statistically significant in the redo Ross group (HR 3.92, 95% CI 1.41-10.94, P = 0.009).
• The incidence of secondary surgical or transcatheter reinterventions was higher in the reoperation group, but there was no statistical significance (HR 2.68, 95% CI 0.93-7.75, P = 0.069).
• There was a statistically higher value of the sinus of Valsalva absolute diameter in the redo Ross group starting immediately after surgery through 10 years of follow-up, although the dynamics of their dilation varied.

In summary, observational data from registries confirm the use of Ross operation in the reoperative scenario as an alternative approach to surgical management with low mortality during the perioperative period. The study findings suggest that since previous cardiac surgery does not prevent the gradual dilatation of the sinus of Valsalva, echocardiography monitoring should be performed lifelong in autograft patients.

Reference:

Arman, S., Ajmi, N., Noly, P.-E., Poirier, N., Bernier, P.-L., Ibrahim, M., Ismail, E.-H., Ismail, B., & Philippe, D. (2026). The Ross Procedure After Previous Aortic Valve Surgery: Propensity-Weighted Comparison of Mid-Term Outcomes. The Journal of Thoracic and Cardiovascular Surgery. https://doi.org/10.1016/j.jtcvs.2026.09.015