title: Results of the Ross operation in rheumatic versus non-rheumatic aortic valve disease.
abstract: OBJECTIVE
  A total of 213 patients underwent the Ross operation at our institution between January 1990 and January 1999. Outcome was assessed in rheumatic (RH) patients and compared with that in patients with other etiology (non-RH).
  
  
  METHODS
  After exclusion of 69 patients with a follow up of <18 months, the study group comprised 144 patients (119 RH, 25 non-RH). Patients were studied clinically and by echo-Doppler cardiography preoperatively, within 2 months and 6-8 months after surgery, and yearly afterwards. Preoperative assessment included age, gender, body surface area (BSA), type of aortic valve lesion and additional valve disease, left and right ventricular outflow tract (LVOT, RVOT) dimensions, and left ventricular (LV) size, function and mass. Postoperatively, patients were studied for presence and severity of autograft regurgitation, mitral regurgitation, LV size, function and mass, and incidence and timing of reoperation.
  
  
  RESULTS
  On average, RH patients were older and had higher BSA, more aortic regurgitation than stenosis, more additional mitral valve disease (mostly regurgitation), larger LV size and poorer LV function. Mitral valve repair was performed in 24% of RH patients versus 0% of non-RH patients. Postoperatively, differences in LV size, function and mass remained present, but diminished during follow up. The autograft reoperation incidence was 22% (26/119) in RH patients versus 8% (2/25) in non-RH patients (p = NS). Preoperative predictors for reoperation in the RH group were severe concomitant mitral regurgitation (MR), followed by male gender and large indexed LVOT (all p<0.001 by discriminant analysis).
  
  
  CONCLUSIONS
  Marked differences were present in patient characteristics between rheumatic and nonrheumatic patients who underwent the Ross operation. Rheumatic patients had a higher incidence of autograft reoperation. Severe concomitant MR was the most important predictor for reoperation in rheumatic patients.
authors.affiliation: Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: F A
authors.initials: FA
authors.lastname: Pieters
authors.forename: Z
authors.initials: Z
authors.lastname: Al-Halees
authors.forename: L
authors.initials: L
authors.lastname: Hatle
authors.forename: M S
authors.initials: MS
authors.lastname: Shahid
authors.forename: M
authors.initials: M
authors.lastname: Al-Amri
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D011184:Postoperative Period; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000503:physiopathology / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left