title: Technical evolution of the Ross operation: midterm results in 186 patients.
abstract: BACKGROUND
  The Ross operation approaches the ideal aortic valve replacement. Between February 1995 and February 2000 we performed 186 procedures. This article reviews modifications introduced reflecting our experience.
  
  
  METHODS
  In all patients the Ross operation was performed as root replacement. Echocardiographic follow-up was complete in 94% of patients.
  
  
  RESULTS
  No operative death or early mortality occurred, nor did thromboembolic or hemorrhagic events. One patient died at 25 months from hemoptysis with pulmonary valve vegetations. Three patients required reoperation for autograft insufficiency. In 1 patient a tethered cusp was repairable and in 2 patients progressive autograft dilatation required autograft replacement. After routinely incorporating support into the aortic annulus and replacing all dilated ascending aorta, autograft dilatation did not recur. For the pulmonary homograft, one outflow patch was placed to relieve a symptomatic gradient. Nine patients with elevated gradients were under observation. Echocardiography revealed autograft median peak systolic gradients of 4.6+/-2.8 mm Hg, pulmonary homograft gradients of 14.8+/-9.6 mm Hg, and nil or insignificant regurgitation.
  
  
  CONCLUSIONS
  The aortic annulus must be supported and the dilated ascending aorta replaced. Root replacement with a short autograft allows consistent results. Pulmonary homograft dysfunction is rare but unpredictable.
authors.affiliation: Sana Herzchirurgische Klinik, Stuttgart, Germany. joboehm@z.zgs.de
authors.forename: J O
authors.initials: JO
authors.lastname: Böhm
authors.forename: C A
authors.initials: CA
authors.lastname: Botha
authors.forename: J G
authors.initials: JG
authors.lastname: Rein
authors.forename: D
authors.initials: D
authors.lastname: Roser
mesh_terms: D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006351:Heart Valves / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012086:Reoperation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome