The following is the summary of “Long-term outcomes with the pulmonary autograft inclusion technique in adults with bicuspid aortic valves undergoing the Ross procedure” published in the January 2023 issue of Thoracic and Cardiovascular surgery by Starnes, et al.

For people with bicuspid aortic valves, this study aims to evaluate the efficacy of the Ross surgery using both wrapped (pulmonary autograft inclusion) and unwrapped (standard) approaches. A single surgeon performed the Ross surgery on 129 adults (aged 18 years) with bicuspid aortic valves between 1992 and 2019. The patients were classified as either having autograft inclusion (wrapped, n=58) or not (unwrapped, n=71). There was a 10.3-year median follow-up (interquartile range, 3.0-16.8 years). Competing risks were used to evaluate the likelihood of requiring autograft reintervention.

There were no significant differences between the group’s preoperative and intraoperative features or 30-day morbidity or mortality between the groups. The unwrapped group had a 97.2% 1-year survival rate, a 95.6% 5-year survival rate, and a 100% 10-year survival rate compared to the wrapped group’s 100%, 100%, and 100% (P=.15). 25  (35.2%) of the unwrapped patients and 3 (5.2%) of the wrapped patients experienced autograft valve failure. Autograft reintervention was found to be lower in the wrapped cohort in a competing risk analysis (subhazard ratio, 0.28;  95% CI, 0.08-0.91; P=.035). 

Autograft reintervention (death as a competing outcome) occurred more frequently in the unwrapped group (10.2%, 14.9%, and 26.8%) than in the wrapped group (4.0%) at 1, 5, and 10 years. Adults with bicuspid aortic valves can avoid further surgery by undergoing the Ross procedure with pulmonary autograft inclusion, stabilizing the aortic root and preventing dilatation. Since the autograft inclusion technique is available, the Ross surgery can be performed on this group with successful long-term results.