O0011: Complexity and Outcomes of Reoperations After the Ross Procedure in the Current Era

Background: The Ross procedure has several advantages, but the need for reintervention is inevitable. The aim of this study was to examine the complexity and outcomes of reoperation after the Ross procedure.

Methods: Retrospective chart review was performed of patients with prior Ross procedure who underwent reoperation at our institution September 1991- January 2021. Demographic, echocardiographic, surgical, and perioperative data were collected. Descriptive statistical and regression analyses were performed.

Results: A total of 105 patients underwent a reoperation at Mayo Clinic after the initial Ross procedure performed at our institution (n=16, 16.2%) or elsewhere (n=83, 83.8%). Mean age at Ross was 27 ±17 years and mean age at reoperation at our institution was 37±19 years. Indications for surgery varied, but 64% had autograft regurgitation as one of their indications for reoperation. Autograft interventions were performed in 77 patients (73.3%). Pulmonary valve or conduit replacement was performed in 56 patients (47.5%). Double root replacement was performed in 11 patients (10.5%). Aortic reconstruction was performed in 37 patients (38.4%). There were 5 early deaths (5%). During a median follow-up of 6.25 years (3 months–24 years) late deaths occurred in 14 patients (13.1%). Patients with ejection fraction < 30% on preoperative echo had shorter duration between Ross and subsequent reoperation (p=0.03).

Conclusion: Reoperations after the Ross procedure are performed for a wide range of indications, with the majority due to autograft dysfunction. Early mortality is not low. Reoperation after Ross should be advised prior to LV systolic dysfunction.