Study Shows Excellent Long-Term Survival for Patients Who Received Ross Procedure
A recent study presented at the 61st annual meeting of The Society of Thoracic Surgeons (STS) demonstrated that patients who underwent the Ross procedure for aortic valve dysfunction have excellent long-term survival rates, with many not having further surgery even after 20 years. The findings, based on a 22-year study at the Narayana Institute of Cardiac Sciences in Bengaluru, India, have the potential to transform the landscape of heart valve replacement for younger patients.
Young patients with severe aortic valve dysfunction often undergo the Ross procedure, a heart valve replacement surgery. It entails replacing the faulty aortic valve with the patient's own healthy pulmonary valve (an autograft), while the pulmonary valve is replaced with donated tissue. The surgery has considerable advantages, particularly for younger patients, because it eliminates the need for lifetime anticoagulant treatment, which is commonly required for patients with mechanical valve replacements.
Dr. Varun Shetty, a cardiac surgeon and the study's lead author, commented, "The Ross operation can be performed safely with results comparable to mechanical valve replacement." He also highlighted the importance of avoiding oral anticoagulants, which have their own hazards. "In fact, most of our patients are not on any cardiac medications following one year after surgery," says Dr. Shetty.
The study followed 252 patients who had undergone the Ross surgery. At 20 years, the survival rate was quite high, with 90.3% of the patients still alive. The findings indicated that the method was beneficial in lowering the need for re-interventions. "We were pleasantly surprised to find that the freedom from re-intervention was 91% at 10 years and 87% at 20 years," says Dr. Shetty.
Despite these hopeful findings, the study raised certain concerns. For example, the absence of pulmonary regurgitation—a condition in which the pulmonary valve fails to seal properly—was lower than that of aortic regurgitation. Researchers discovered that it gradually decreased over time, from 97% at five years to 75.1% at twenty years. Dr. Shetty noted that people aged 18 and younger had a greater incidence of aortic regurgitation. He also mentioned the connection between late autograft failure and factors such as a dilated aortic annulus and ascending aorta.
The study also found that the treatment had considerable advantages versus mechanical valve replacement, particularly for younger patients. Because the Ross operation employs living tissue, the valves can develop alongside a growing kid, making it a popular choice for paediatric patients. "The most important message from our study is that the Ross procedure offers excellent long-term survival rates with low risk of reintervention even at 20 years," says Dr. Shetty. "This makes the Ross operation an excellent substitute for mechanical valve replacement."
Dr. Shetty's team also compared their findings to those documented in the STS Congenital Heart Surgery Database (CHSD), which contains over 600,000 records from heart surgeries around the world. The comparison demonstrated the successful international implementation of the Ross process, not limited to high-volume centres such as the Narayana Institute. "Our study, performed at a single high-volume surgical centre in India, demonstrates that the Ross procedure can be performed with reproducible success across the globe," according to Dr. Shetty.
This study contributes to the expanding body of evidence supporting the use of the Ross technique, particularly in younger patients. With minimal long-term mortality and the added benefit of not requiring lifetime medication, it may become the preferred option for patients with aortic valve dysfunction, particularly those under 40.
The study's findings are remarkable and reassuring for both patients and clinicians. It has been shown that the Ross method can improve long-term survival rates and get rid of the need for follow-up surgeries. This makes it a good, safe, and long-lasting alternative to mechanical valve replacements. While the findings are encouraging, they also underscore the importance of ongoing monitoring and personalised care, particularly for younger patients who are at a higher risk for aortic regurgitation. Still, the study is an essential reminder of how breakthroughs in heart surgery can greatly improve patient outcomes, giving hope to people suffering from aortic valve disease.