Revisiting the Ross operation: early results from a new Ross program at a cardiovascular center in South America.

Abstract

Aortic valve disease in young adults remains challenging due to long life expectancy and the need for durable, anticoagulation-free solutions. The Ross procedure offers excellent hemodynamics and long-term durability but is underutilized in Latin America because of its technical complexity and limited homograft availability. We conducted an observational study including all adult patients undergoing the Ross procedure between July 2024 and April 2026 at Hospital Clínico UC-Christus. Demographics, clinical history, surgical indications, operative details, complications, and echocardiographic follow-up were analyzed. 29 consecutive patients were included (13.8% female; range: 21-61). Main surgical indications were severe aortic stenosis (34.5%), mixed lesions (34.5%) and severe aortic regurgitation (27.6%); 86.2% had bicuspid aortic valves. Associated procedures were performed in 24.1% of cases. Median cross-clamp and cardiopulmonary bypass times were 205 and 230 min, respectively. Early complications included perioperative stroke in 3 patients (10.3%; all ischemic, two recovered with mRS: 0-1 and one with mRS: 3). Early echocardiography follow-up showed no neoaortic regurgitation in 18 patients, trivial in 9, and mild in 2, with a median neoaortic gradient of 4.0 mmHg and neopulmonary gradient of 2.0 mmHg. No patient developed severe autograft or homograft regurgitation. During a median follow-up of 295 days (range: 30-662), no deaths were observed. There was 1 reintervention due to homograft endocarditis. Implementation of a dedicated Ross program in a high-complexity Latin American center is feasible and was associated with acceptable early postoperative outcomes. These findings support feasibility and short-term safety only; longer follow-up and larger cohorts are required before conclusions can be drawn regarding durability or wider safety.