Fully Supported Ross Procedure is Associated With Neo-Aortic Regurgitation in Adolescents and Young Adults

OBJECTIVES: The aim of this study was to evaluate the impact of different autograft support techniques during the Ross procedure on long-term outcomes in adolescents and young adults. METHODS: Patients (≥12 years) who underwent a Ross procedure between 01/1996 and 10/2024 were included. According to autograft support technique, they were divided into 3 groups: No support, Annular support, and Full support (autograft placed inside a straight Dacron graft). Survival was estimated using the Kaplan-Meier method. Cumulative incidence of autograft regurgitation ≥moderate and autograft (+/- valve-sparing) root replacement were analysed using the Gray subdistribution method. RESULTS: Out of 131 patients included (median age 17.2 years [IQR: 14.5-24.0]), 76 (58%) had No support, 43 (33%) Full support, and 12 (9%) Annular support. Patients in group No support were significantly younger (P < .01) and had smaller native aortic annulus (24 mm vs 26 mm, P < .05). Postoperative complications (P = .40) and early mortality (P = 1.0) were similar across groups. Median follow-up was 5.7 years (IQR: 2.1-11.8), and 10-year survival was 99%. While cumulative incidence of reoperation was similar between the 3 groups at 10 years (5.6% vs 0% vs 10.1%, P = .80), patients with Full support experienced a significantly higher rate of autograft regurgitation ≥moderate (32.3% vs 13.3% vs 11.1%, P = .03). CONCLUSIONS: Long-term survival after the Ross procedure was excellent in adolescents and young adults. Full support is associated to autograft valve dysfunction at 10 years, while annular support gave more stable autograft outcomes. Further studies are needed to determine whether this reflects a technical learning curve or a reproducible pattern.