20-Year Outcomes after the Ross Procedure for Treatment of Aortic Valve Disease

All articles of this category (opens in new window) Background: Past studies suggest excellent long-term survival beyond 15 years after the Ross procedure. However, these studies have significant statistical limitations. It was the aim of this study to investigate survival 20 years or more after the Ross procedure. Methods: All patients aged > 16 years who underwent the Ross procedure at our institution at least 20 years ago were investigated. Survival after Ross was compared with indirectly standardized survival of the general population matching the sex, age in the year of surgery of the Ross population. Individual trajectories were averaged after logit transformation. Confidence limits were used for the logit-transform. Results: A total of n = 298 patients were included in this study. Ross procedure was performed between February 1990 and April 2003. The median age was 46 (IQR: 35–56) years, and 78% were male. At 20 years after the Ross procedure, estimated Kaplan–Meier survival was 81.7% (95% CI: 76.5–86.0) compared with 85.3% in the general population. So, the loss in survival at 20 years was 3.6% (95% CI: −0.7% to 8.8%). Survival of Ross patients seems to decline a few years after that time point. Conclusion: Our specifically designed study fails to demonstrate that survival after the Ross procedure in adult patients differs from that of the general population at 20 years after surgery, although confidence limits extended just 5% to either side. One may hypothesize that there may be a loss later than that, but not earlier. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany