Abstract 16373: A Single Center 25-Year Experience With the Ross Procedure in Over 200 Patients.

Introduction: The Ross procedure remains the gold standard surgical therapy for severe aortic valve dysfunction in children and young adults. With the emergence of evolving surgical techniques for aortic valve disease (e.g. Ozaki reconstruction) and transcatheter-based valve technology, defining true long-term outcomes and surgical benchmarks for the Ross procedure remain critical for future comparisons. Methods: All patients undergoing the Ross procedure at a single institution for severe aortic valve dysfunction were evaluated over a 25-year study period (1993-2018). Patients were stratified into age categories: I (< 1y, 14%), II (1-10y, 26%), III (11-17y, 27%) and IV (>18y, 33%). Univariate and Kaplan-Meier analyses evaluated operative and long-term outcomes. Results: A total of 201 patients underwent the Ross (73%) +/- Konno (27%) procedure. Mean patient age was 16±14y (range <1-56y). Long-term follow-up was 100% (mean 5±7y, range <1-21y). Isolated aortic insufficiency (45%) was the most common surgical indication among all patients, while isolated aortic stenosis (52%) was most common in Age I. A pulmonary homograft RV-PA conduit was utilized for the majority (89%) of RVOT reconstructions. Overall mortality was 1.5% and was highest among infants (Age I: 7%). Importantly, Kaplan-Meier long-term survival was high across age groups: I (93% at 18 years), II (98% at 20 years), III (100% at 19 years), and IV (100% at 20 years). Freedom from autograft and RVOT reinterventions (Figure) were also lowest for infants, with strong durability of 10-15 years in older cohorts. Importantly, the overall incidence of moderate-severe neo-aortic insufficiency after Ross was 11% and not associated with underlying aortic valve pathology (P =0.25). Conclusions: Operative and long-term results for the Ross procedure remain promising with excellent survival and long-term durability of the neo-aortic autograft. Neonates and infants remain the highest risk cohort with the earliest need for RVOT re-intervention. Primary aortic valve pathology was not associated with development of autograft dysfunction after Ross. These long-term data provide critical benchmarks to which prosthetic AVR as well as future surgical and catheter-based therapy should be compared. [ABSTRACT FROM AUTHOR]