9 November 2023
A study published in JAMA Cardiology has shown that patient’s undergoing the Ross procedure, an operation in which the patient’s aortic valve is replaced with their own pulmonary valve and the latter replaced with a healthy donor valve, have excellent long-term survival into the third decade after surgery. This is a marked improvement on the long-term survival of patients undergoing valve replacement with artificial valves (mechanical or animal tissue).
The patients, all operated upon by Professor Sir Magdi Yacoub between 1994 and 2001, have been followed-up at Harefield Hospital. The study, led by Royal Brompton and Harefield Hospitals consultant cardiac surgeons, Mr Fabio De Robertis and Mr Jullien Gaer, was a collaborative project in which all data were analysed jointly with the Erasmus University Medical Centre in Rotterdam, Netherlands; the Sapienza University, Italy; the Icahn School of Medicine at Mount Sinai Hospital, USA; Imperial College London, UK; the Magdi Yacoub Foundation, Egypt and the University of Pennsylvania, USA.
Aortic valve disease
The aortic valve is the valve through which blood is pumped by the heart and distributed around the body. Aortic valves can become obstructed, or leak, or a combination of the two; when this occurs, the heart has to work progressively harder to pump blood around the body and, left untreated, eventually fails.
The Ross procedure
The best aortic valve substitute remains a matter of debate but the current study has added significantly to the scientific evidence required to inform what is often a complex decision. The options include artificial valves, made from metallic alloys or animal tissue, and human valves, as in the Ross procedure. The beauty of the Ross operation is that the failing aortic valve is replaced with the patient’s own living valve. The new aortic valve functions extremely well, as well as a normal valve.
The study findings
The study found that patients undergoing the Ross procedure had excellent long-term survival and functional outcome, crucially with a very low incidence of re-operation after almost thirty years. Moreover, it is largely free of the complications associated with artificial valves such as infection, stroke and thrombosis.
The survival of the patients in this study was comparable with that of the general population. In other words, patients undergoing the Ross operation can expect a life expectancy and quality of life that is comparable with that of people who do not have aortic valve disease. The authors sound a caveat though: the Ross procedure is a more complex procedure than conventional aortic valve replacement and is therefore not appropriate in all patients.
Mr Gaer and Mr De Robertis said: “the Ross procedure is enjoying a renaissance in North America and continental Europe. As yet, relatively few centres in the UK that have taken it up. We believe that these results are such that all patients under the age of 60 should consider the Ross operation as an alternative to conventional aortic valve replacement.
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