Short-Term Outcomes of the Ross Procedure in Patients Greater and Less than 45 years of Age

P0306 

Abstract Submission 

Anne Reimann-Moody (1), Arjune Dhanekula (2), Michael Shang (2), Audrey Mossman (3), Rachel Flodin (2), David Mauchley (2), Chris Burke (2), Scott DeRoo (2)

(1) University of Washington, Bozeman, MT, (2) University of Washington, Seattle, WA, (3) University of Washington, Laramie, WY

Anne Reimann-Moody    -  Contact Me
University of Washington

Arjune Dhanekula    -  Contact Me
University of Washington

Michael Shang    -  Contact Me
University of Washington

Audrey Mossman    -  Contact Me
University of Washington

Rachel Flodin    -  Contact Me
University of Washington

David Mauchley    -  Contact Me
University of Washington

Christopher Burke    -  Contact Me
University of Washington

Scott DeRoo    -  Contact Me
University of Washington

Anne Reimann-Moody    -  Contact Me
N/A

Objective: In the past decade, the Ross procedure has experienced a resurgence in popularity due to improved autograft longevity and potentially enhanced survival compared to current prosthetic valves. However, few studies have examined outcomes in patients older than 45 years old. In this study, perioperative outcomes after Ross procedure were compared between patients aged  45 (middle-aged) and patients < 45 (young).

Methods: From June 2020 to July 2023, 79 patients underwent a Ross procedure at one academic center. After excluding patients under age 18, 76 patients were stratified into cohorts of ages 18-44 (mean 32 ± 6.47 years, n=47) and ages  45 (mean 54.1± 5.23 years, n=29). Preoperative demographics, intraoperative characteristics, perioperative, and short-term outcomes were collected from the electronic health record. Normality of the variables was assessed using the Shapiro-Wilk test. Statistical comparisons were then performed using the t-test or the Mann-Whitney test for continuous variables, and Fisher's exact test for categorical variables.

Results: Mean age of the entire cohort was 40.4 ± 12.36 years, 72% of patients were male, and mean follow-up time was 10.8 months. 25% of patients (n=19) had prior cardiac surgery. Shortness of breath was the most common presenting symptom (47%, n=36), while 27% (n=21) were asymptomatic. 88% (n=67) had a preoperative EF of over 55%. The middle-aged cohort had higher rates of hypertension (48% vs 21%, p<0.05), hyperlipidemia (62% vs 6%, p=0.001), coronary artery disease (21% vs 2%, p=0.011) and a higher BMI (30.59 vs 25.72, p=0.002). Middle-aged patients had more isolated aortic stenosis, compared to a mixed pathology with an aortic stenosis predominance in the young cohort (69% vs 47%, p=0.002). Bypass time, cross-clamp time, and number of concomitant procedures performed were similar between cohorts. Post-operatively, the middle-aged cohort had a higher rate of atrial fibrillation (31% vs 11%, p <0.05), more frequently required prolonged inotropes (21% vs 2%, p<0.05), and had a longer median length of stay (8 days vs 7, p=0.02). There was one stroke in the middle-aged group, no in-hospital mortality in either group, and no significant difference in frequency of post-op pacemaker placement, reintervention, or readmission.

Conclusions: Peri-operative and short-term outcomes of the Ross procedure are similar when comparing cohorts of patients aged 18-44 and 45-60 years. It is reasonable to consider a Ross procedure in select middle-aged adults at an experienced Ross center.

Aortic Root