title: The Ross operation as a combined procedure and in complicated cases--is there an increased risk?
abstract: BACKGROUND
  In this report we address the question whether the Ross operation can be recommended in combined and complicated cardiac procedures.
  
  
  METHODS
  From February 1995 to July 2000, we performed 203 Ross operations, 129 with ideal clinical presentation (group 1: mean age 41 +/- 13 years, male 105). In 74 patients, the clinical presentation was complex (group 2: mean age 35 +/- 17 years, male 57), defined as previous aortic or cardiac operations in 32, active endocarditis in 8 or combined procedures in 40 patients. Follow-up is 95 % complete.
  
  
  RESULTS
  Neither early mortality nor thromboembolic events were observed. Complications in group 1 vs. group 2 were prolonged ventilation in 1 vs. 1, pacemaker insertion in 1 vs. 2, minor myocardial infarction in none vs. 2 and postoperative bleeds in 2 vs. 3 patients. In group 1, one patient died of hemoptysis at 25 months, and in group 2 one sudden death occurred at 5 months. In the long term, two patients required reoperation for autograft failure in group 1, and one on group 2. Pulmonary stenosis required surgical treatment in one patient of group 2. Echocardiography revealed physiological gradients across the autograft with no significant regurgitation in either group.
  
  
  CONCLUSIONS
  The Ross operation has excellent mid-term results and is a safe and attractive therapeutic approach, both in combined procedures and complex clinical presentations.
authors.affiliation: Sana Herzchirurgische Klinik, Herdweg 2, 70174 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: W
authors.initials: W
authors.lastname: Hemmer
authors.forename: D
authors.initials: D
authors.lastname: Roser
authors.forename: C
authors.initials: C
authors.lastname: Starck
authors.forename: G
authors.initials: G
authors.lastname: Blumenstock
authors.forename: J G
authors.initials: JG
authors.lastname: Rein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004452:Echocardiography; D004696:Endocarditis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology*; D011666:Pulmonary Valve Stenosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome