Health‐Related Quality of Life Following the Ross Procedure: A Systematic Review

The Ross procedure provides a living autologous aortic valve substitute and avoids lifelong anticoagulation, but its effect on health‐related quality of life (HRQoL) relative to alternative aortic valve strategies remains incompletely defined. We conducted a systematic review of studies published from January 2000 to 17 September 2026 evaluating postoperative HRQoL after the Ross procedure using validated patient‐reported outcome instruments. Twelve studies met the eligibility criteria. Six directly compared Ross recipients with mechanical aortic valve replacement (mAVR): three reported significantly better Ross outcomes in at least one SF‐36 domain, one favoured the mechanical group in selected domains, and two found no significant difference. A randomised comparison with homograft aortic root replacement demonstrated higher physical functioning, general health and physical component scores after Ross at long‐term follow‐up. Comparisons with aortic valve repair were generally similar. Paediatric and young‐adult studies demonstrated generally preserved HRQoL compared with healthy or relevant reference populations, although psychological concerns were identified in selected cohorts. Contemporary long‐term data using PROMIS‐10 and MacNew similarly demonstrated preserved physical and favourable mental and disease‐specific HRQoL after Ross. Important limitations included substantial clinical and methodological heterogeneity, absence of preoperative HRQoL in most studies, residual confounding in observational comparisons and selection/non‐response bias. Available evidence suggests that long‐term HRQoL after the Ross procedure is generally preserved, with selected domain‐level advantages reported against mAVR and homograft comparators. However, the heterogeneous and predominantly observational evidence base does not establish global HRQoL superiority of Ross over alternative aortic valve procedures.