182 * THE ROSS PROCEDURE IN YOUNG ADULTS: OVER 20 YEARS' EXPERIENCE IN A SINGLE CENTRE

Objectives: To analyse the long-term outcomes of the pulmonary autograft (Ross procedure) in young adults. Methods: From 1991 to 2014, 276 consecutive adult patients underwent elective aortic valve replacement with the pulmonary autograft. The mean age of this cohort was 41.4 ± 9.7 years, the aetiology of the aortic disease was degenerative in 51%, rheumatic 5.8% and endocarditis 9.1%. The implantation techniques used were: subcoronary (n = 5), freestanding root (n = 160) and inclusion (n = 111; 101 into the aorta, 10 into a Valsalva graft). Median duration of follow-up was 11.3 years (IQR: 7.3–15.3). Results: Sixty-day mortality was 1.8% (n = 5). Completeness of follow-up was 94%. Valve-related bleeding or thrombo-embolism events occurred in 19 patients for a linearised rate of 0.7%/year. Late valve reoperation was required in 39 patients (14.3%): 29 on the aortic valve, 3 on the pulmonary valve, 7 on both valves. Freedom from any valve reoperation was therefore 96.6 ± 1.2%, 88.4 ± 2.3% and 75.1 ± 4.2% at 5, 10 and 15 years, respectively. Overall survival was 97.1 ± 1.1%, 95.0 ± 1.5% and 89.0 ± 2.7% at 5, 10 and 15 years, respectively. Univariate Cox-regression analysis revealed that aortic insufficiency as the predominant form of valve disease at time of surgery was a significant predictor of late valve reoperation (HR: 2.18, 95% CI: 1.15–4.15). Conclusion: The Ross operation has shown a low perioperative mortality and a low incidence of major bleeding or thrombo-embolic complications during follow-up. Despite a significant risk of valve reoperation over time, the long-term survival of these patients is excellent. An improved freedom from reoperation is expected with the implementation of the inclusion technique.