Outcomes and quality of life after Ross reintervention: would you make the same choice again?

BACKGROUND: The Ross procedure was introduced as a long term if not definitive solution for aortic pathology. However, the rate of reoperation is not negligible.

METHODS: Single center prospective study assessing the general outcome of Ross reoperation and patients perceived quality of life compared with two control groups (Ross non reoperation and mechanical aortic valve replacement). Patient's preference, regarding the choice between mechanical aortic valve and Ross procedure, was investigated in a subgroup who could theoretically have been directed to either of the two procedures.

RESULTS: Between 2005 and 2017, 64 consecutive patients underwent reoperation after Ross. Median age was 31 years. Median freedom from reoperation after Ross procedure was 136 months. Forty-nine patients required autograft reoperation and 25 had homograft failure. No in-hospital mortality was recorded. Mean follow-up was 77 months(range 6-164). Short Form Health Survey (SF-36) questionnaire was administered, to assess the quality of life. Ross reoperation group showed a lower score involving psychological concerns compared to other groups. In reoperated patients group, 52 had adequate aortic annulus dimensions to receive a prosthetic valve instead of a Ross procedure. When asked if they would make the same choice, only 31% confirmed the preference.

CONCLUSIONS: Reoperations after Ross procedure have low mortality and morbidity. Long-term follow-up showed a high quality of life, even after reoperations. However, due to psychological concerns following redo surgery, when choosing a Ross procedure, it is our duty to thoroughly explain to patients that in case of reoperations a high level of disillusion is predictable.