This database study examined hospital surgical volumes and outcomes among 1,212 adults undergoing the Ross procedure during 2016–2022. Major adverse events included mortality, stroke, prolonged ventilation, acute renal failure, pulmonary embolism, cardiac arrest, and reoperation. Event rates were 42.1% at low-volume centers, 8.8% at adult high-volume centers, and 3.8% at pediatric high-volume centers. After adjustment, low-volume versus pediatric high-volume care was associated with greater odds of major adverse events (odds ratio 7.7, 95% confidence interval 3.0–19.7). Reoperation rates were higher at adult than pediatric high-volume centers (4.5% versus 0.6%).
Hospital surgical volume was associated with substantial differences in major complications after the adult Ross procedure. These findings identify a potentially important center-level risk marker, not a causal effect of volume.
Study limitation: The observational database design leaves potential residual confounding, and the composite endpoint does not establish a mortality benefit.
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