(P256) NORTH AMERICAN TRENDS IN UTILIZATION AND IN-HOSPITAL OUTCOMES OF THE ROSS PROCEDURE

Background: In recent years, there has been a resurgence of interest in the Ross procedure as an alternative to conventional aortic valve replacement (AVR) in young and middle-aged adults. This study sought to evaluate contemporary trends in utilization of the Ross procedure in adults and investigate the relationship between surgical volumes and in-hospital outcomes.

METHODS AND RESULTS: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for patients who underwent the Ross procedure between 2008 and 2023. We used mixed-effects logistic regression, incorporating center- or surgeon-specific random intercepts, to investigate the relationship between Ross volumes and in-hospital mortality. Statistical significance was evaluated using likelihood ratio tests.

Between 2008 and 2023, a total of 2,268 Ross procedures were reported. Median age was 43 years (IQR: 32–52), and 1,550 (68%) patients were male. Utilization of the Ross procedure reached a nadir in 2017 (n=63) before increasing annually, reaching 531 cases in 2023 (Figure 1A). In 2017, Ross procedures represented 0.9% of all AVRs performed on patients aged ≤60 years; by 2023, this proportion had increased to 7.2% (Figure 1A). The risk of in-hospital mortality associated with the Ross procedure declined from 2.8% in 2008 to a nadir of 0.9% in 2020 before increasing to 1.9% in 2023 (Figure 1B). Compared with centers that performed more than 10 Ross procedures annually, in-hospital mortality was higher in centers that performed only 1 or 2 Ross operations per year (OR 4.5 [95% CI: 1.5–13.2]; p=0.006) (Figure 2A). Similarly, compared with surgeons who performed more than 10 Ross procedures per year, in-hospital mortality was higher for surgeons who performed only 1 or 2 Ross operations per year (OR 3.8 [1.2–12.2], p=0.007) (Figure 2B).

Conclusion: Utilization of the Ross procedure is increasing in North America. There is a clear inverse relationship between the volume of Ross procedures and early surgical outcomes. The operative mortality of the Ross procedure is unacceptably high when performed in low-volume centers or by low-volume surgeons. The Ross procedure should only be performed in high-volume comprehensive valve centers of excellence.