Interest in the Ross procedure as an alternative to conventional aortic valve replacement has increased among younger adults. A registry analysis published in the Journal of the American College of Cardiology examined recent trends in Ross procedure use and the association between surgical volume and operative mortality.

The analysis used data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and included adults who underwent the Ross procedure from 2008 through 2023. It evaluated utilization patterns and operative outcomes across centers. Modified Poisson regression with generalized estimating equations assessed the relationship between Ross procedure volume and operative mortality while adjusting for clustering by center and year.

Across 194 centers, a total of 2,268 Ross procedures were reported between 2008 and 2023. The median patient age was 43 years (Q1-Q3: 32-52 years). Over the 16-year study period, centers performed a median of 2 Ross procedures (Q1-Q3: 1-7). Ross procedure utilization reached its lowest level in 2017 with 63 cases, after which annual utilization increased, reaching 531 procedures in 2023. Among adults ≤60 years undergoing aortic valve replacement, the proportion of Ross procedures rose from 0.9% in 2017 to 6.7% in 2023.

Operative mortality decreased from 4.4% in 2008 to 1.0% in 2020, before rising to 2.5% in 2023. Regression-adjusted modeling showed that higher center- and surgeon-level Ross procedure volumes corresponded with lower operative mortality (P < 0.001), with substantial improvements noted beyond approximately 10 procedures per year.

Ross procedure use increased substantially over the study period. Higher institutional and surgeon procedure volumes were associated with lower operative mortality.