Ross procedure study finds durable results in adults with aortic valve disease

A large North American study links the Ross procedure for aortic valve replacement with durable valve function and strong long-term outcomes in adults. The findings matter because they suggest the operation may fit some patients who have often been steered toward tissue or mechanical valves, according to Mount Sinai researchers.

The study, led by Mount Sinai heart surgeon Ismail El-Hamamsy and published in the Journal of the American College of Cardiology, followed 455 adults who had the Ross procedure from 2011 through 2019. Mount Sinai said it is the largest North American study to date of the operation.

The Ross procedure treats a diseased aortic valve by moving the patient’s own pulmonary valve into the aortic position. Mount Sinai said the approach differs from standard mechanical or biological valve replacement because it uses living tissue from the patient rather than a nonliving substitute.

According to the researchers, that feature allows the valve to function more like a native aortic valve. Mechanical valves can last for long periods but require lifelong anticoagulation, while biological valves can deteriorate over time, especially in younger patients, Mount Sinai said.

Results at 12 years

All operations in the study were performed by El-Hamamsy and his team, and patients were followed through a dedicated program that included regular clinical checks and yearly echocardiograms. The average patient age was 48; half were older than 50, 10% were older than 60, and the oldest patient was 67.

At 12 years after surgery, survival matched that of the general population, according to the study. More than 96% of patients had not needed another cardiac intervention, and more than 98% had no significant dysfunction of the aortic valve.

The study also reported that fewer than 1% of patients needed a permanent pacemaker, a rate Mount Sinai described as substantially lower than those reported after conventional aortic valve replacement. Researchers found no cases of patient-prosthesis mismatch, in which an implanted valve is too small for the patient’s body size, and no cases of aortic valve endocarditis.

Among the 3.5% of patients who needed another intervention within 12 years, most were treated with minimally invasive transcatheter procedures rather than another open-heart operation, the study found.

Older adults and regurgitation

The findings also address two groups that have often been considered less suitable for the Ross procedure: adults over 50 and patients with aortic regurgitation. Aortic regurgitation occurs when the valve does not close properly and blood leaks backward into the heart’s main pumping chamber.

Researchers compared patients with aortic stenosis, in which the valve narrows and restricts blood flow, with those who had aortic regurgitation. The study found no difference at 12 years in aortic valve function or the need for reintervention between the groups.

El-Hamamsy said in Mount Sinai’s release that the results support use of a tailored surgical approach for patients with aortic regurgitation and challenge the routine use of tissue or mechanical valves in some adults older than 50.

The researchers cautioned that the results depend on surgical expertise, institutional experience and structured follow-up. El-Hamamsy, director of the Adams Valve Institute at The Mount Sinai Hospital, has performed nearly 1,000 Ross procedures and has helped start more than 40 Ross programs in 15 countries, according to Mount Sinai.

Mount Sinai said interest in the operation is growing as researchers also work on tissue-engineered heart valves that could broaden treatment options for aortic valve disease.

This story draws on original reporting from Medical Xpress.