Mentoring the Ross Procedure in Adults Does Not Compromise Perioperative or Long-term Outcomes

Abstract

Background: Recent reports that the Ross procedure restores normal life expectancy in young adults with aortic valve disease have renewed interest in this complex procedure. Because only a few centers perform a high volume of Ross procedures, there are limited data on the safety of learning and teaching the Ross procedure.

Methods: A total of 234 consecutive adult patients at a single center underwent the Ross procedure performed by an experienced surgeon acting as the primary operator (n = 186; 1994-2021) or mentoring surgeon (n = 48; 2001-2021). Cumulative sum analysis of cardiopulmonary bypass times was performed to evaluate learning curves as primary surgeon and mentored surgeon. Kaplan-Meier analysis was used to estimate long-term survival and freedom from Ross-related reintervention.

Results: Patients' mean age was 42 ± 11 years; 169 (72%) were male. Baseline demographic characteristics were similar between cohorts. Operative death occurred in 5 (2%) patients: 3 (2%) as primary surgeon and 2 (4%) as mentor (P = .28). In-hospital reoperation was required in 8 (3%) patients: 6 (3%) as primary surgeon and 2 (4%) as mentor (P = .75). Up to 10 years, there was no difference in survival between primary operator cases and mentored cases (94.4% [91.2%-97.9%]) vs 95.8% [90.3%-100%]; log-rank, P = .85).

Conclusions: Although the Ross procedure is technically complex, it can be taught to experienced aortic root surgeons without compromising short- or long-term outcomes.

Figure

Kaplan-Meier survival of patients undergoing Ross procedure by the surgeon acting as primary operator or a mentor.