title: Ross procedure. Inserting the autograft using a fully supported root replacement method; techniques and results.
abstract: OBJECTIVE
  The root replacement (RR) method for insertion of the pulmonary autograft (PA) has resulted in improved immediate aortic valve competence. However, the unsupported pulmonary artery wall is thinner, more elastic, and thus more prone to dilatation than the normal aortic root. This might predispose to late aortic regurgitation (AR) due to splaying of the aortic commissures, similar to the mechanism of AR in Marfan's syndrome.
  
  
  METHODS
  A fully supported root replacement (FSRR) method was designed and implemented in 78 patients, with preservation of the aortic root and proximal ascending aortic remnant fully to surround and support the PA root. Additional aortic annulus reduction was performed in 29 patients, and adjustment of the sinotubular diameter in 27.
  
  
  RESULTS
  Seventy-eight patients were analyzed with sequential Doppler echocardiography. The maximal neoaortic sinus diameter remained constant for up to three years after surgery (mean 34.3 +/- 4.0 mm) compared with before surgery (35.2 +/- 4.0 mm). There was one early death, no late deaths or reoperations, and at last follow up AR was nil/trivial in 72% of patients, mild in 27% and moderate in 1%. There was no progression of AR over four years' follow up. By comparison, four patients previously underwent unsupported RR for insertion of the PA; in these patients, mean neoaortic sinus diameter increased significantly from 31 +/- 6 mm to 41 +/- 3 mm at three years after surgery (p = 0.005).
  
  
  CONCLUSIONS
  Insertion of the PA using a FSRR method prevents dilatation of the neoaortic sinuses and sinotubular junction without need for prosthetic material, and provides similar results to conventional RR with regard to aortic valve competence. Retaining the advantages of RR in this manner and maintaining aortic root size may prove valuable in the longer term.
authors.affiliation: Department of Cardiac Surgery, Epworth Hospital, Parkville Vic, Australia.
authors.forename: P D
authors.initials: PD
authors.lastname: Skillington
authors.forename: J A
authors.initials: JA
authors.lastname: Fuller
authors.forename: L E
authors.initials: LE
authors.lastname: Grigg
authors.forename: A G
authors.initials: AG
authors.lastname: Yapanis
authors.forename: G F
authors.initials: GF
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D002315:Cardiopulmonary Bypass; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000637:transplantation*; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome