{"id":"46083","type":"article","url":"https://hartvaat.nl/2026/04/17/langetermijnuitkomsten-na-de-ross-operatie-een-op-de-vier-krijgt-een-heroperatie/","title":"Langetermijnuitkomsten na de Ross-operatie: één op de vier krijgt een heroperatie","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003782?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003782?rss=1","authors":["Mahmoud","M.","Johansson","B.","Rinnstro&#x0308;m","D.","Sandberg","C.","Christersson","C.","So&#x0308;rensson","P.","Trzebiatowska-Krzynska","A.","Mandalenakis","Z.","Hlebowicz","J.","Ljungberg","J."],"significance":5,"published":"2026-07-22","source_date":"2026-04-17","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/antistolling-bij-vte/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"In aortic valve disease, the Ross procedure — transposing the patient's own pulmonary valve to the aortic position with a homograft in the pulmonary position — remains an alternative for young patients or those avoiding long-term anticoagulation. Long-term prognosis, however, was largely unknown. In the Swedish congenital heart disease registry, 82 adults after a Ross procedure were identified (mean age at the procedure 23.6 years). After a mean of 16.8 years, 24.4% had undergone a first reoperation — cumulative incidence about 15% at 10 years and 30% at 20 years — mostly on the pulmonary valve (85%). Mortality was low (2.3%). In selected patients the Ross procedure thus remains a viable option, provided late morbidity is considered; secondary Ross surgery was associated with better left ventricular function.","created":"2026-07-03T20:27:17Z","updated":"2026-07-04T19:09:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Bij aortaklepziekte blijft de Ross-operatie — waarbij de eigen pulmonalisklep naar de aortapositie wordt verplaatst en een homograft in de pulmonalispositie komt — een alternatief voor jonge patiënten of wie langdurige antistolling wil vermijden. De langetermijnprognose was echter grotendeels onbekend. In het Zweedse register voor aangeboren hartafwijkingen werden 82 volwassenen na een Ross-operatie geïdentificeerd (gemiddelde leeftijd ten tijde van de ingreep 23,6 jaar). Na gemiddeld 16,8 jaar had 24,4% een eerste heroperatie ondergaan — de cumulatieve incidentie was circa 15% na 10 jaar en 30% na 20 jaar — meestal aan de pulmonalisklep (85%). De sterfte was laag (2,3%). Bij geselecteerde patiënten blijft de Ross-operatie dus een goede optie, mits men rekening houdt met de late morbiditeit; een secundaire Ross-operatie ging gepaard met een betere linkerventrikelfunctie.","abstract_original":"<sec><st>Introduction</st>\n<p>In aortic valve disease, several interventions are available. In young people who are still growing, or considering the risks of long-term anticoagulation, the Ross procedure remains an alternative for aortic valve replacement. This procedure entails the transposition of the patient&rsquo;s pulmonary valve to the aortic position, with placement of a homograft in the pulmonary position. However, long-term prognosis remains largely unknown.</p>\n</sec>\n<sec><st>Methods</st>\n<p>The Swedish national registry of congenital heart disease was searched for adult patients with a history of Ross operation.</p>\n</sec>\n<sec><st>Results</st>\n<p>82 patients (mean age 40.4&plusmn;15.8 years) were identified, with a mean age at the time of the Ross procedure of 23.6&plusmn;14.7 years. After a mean follow-up of 16.8&plusmn;5.5 years, 24.4% of patients underwent a first reoperation involving either the neoaortic valve or the pulmonary homograft, at a mean age of 32.0&plusmn;13.9 years. The cumulative incidence of reoperation was approximately 15% at 10 years and 30% at 20 years post-Ross procedure. Among the 20 reinterventions, 17 (85.0%) involved the pulmonary valve and 8 the neoaortic valve; five patients underwent procedures on both valves. Two patients (2.3%) died during follow-up.</p>\n<p>Forty-eight patients in the cohort had undergone primary Ross surgery. This subgroup was older at the time of data extraction (mean age 46.7&plusmn;15.7 years) compared with those who underwent secondary Ross surgery (mean age 31.3&plusmn;10.7 years), that is, typically following previous interventions. The secondary Ross group demonstrated better left ventricular function, with ejection fraction &gt;50% in 91.7% of cases, compared with 69.8% in the primary group (p=0.041).</p>\n</sec>\n<sec><st>Conclusion</st>\n<p>One in four patients undergoing the Ross procedure requires a reintervention, commonly involving the pulmonary valve. Long-term mortality was low. In selected patients, the Ross procedure remains a viable option; however, late morbidity must be considered. Our findings suggest that secondary Ross surgery is associated with better long-term outcomes, particularly regarding left ventricular function, although the underlying mechanisms remain unclear.</p>\n</sec>"}