title: Ross operation for bicuspid aortic valve disease in adults: is it a valid surgical option?
abstract: OBJECTIVE
  The validity of the Ross operation as freestanding root replacement in adult patients with bicuspid aortic valve disease has lately been questioned. We have analyzed retrospectively our results in 23 adult patients (19 males) operated for bicuspid aortic valve disease ad modum "Ross" employing a freestanding root replacement technique.
  
  
  METHODS
  In 9 patients the dominant aortic valve lesion was stenotic (aortic stenosis group) and in the remaining 14 patients it was aortic insufficiency (aortic insufficiency group). The fate of the pulmonary autograft in the two groups was studied. The intraoperatively measured aortic and pulmonary annuli diameters from the two groups were compared with those from a population of normal looking aortic and pulmonary valves matched for body surface area.
  
  
  RESULTS
  The aortic insufficiency group needed significant reduction of the aortic annulus diameter to conform to the size of the pulmonary autograft. The pulmonary autograft annuli in this group were significantly larger in diameter than the ones in the aortic stenosis group. The mean pulmonary annulus diameter in the aortic stenosis group was, on the other hand, significantly smaller when compared with that in the normal matched population. After a mean follow-up period of about 19 months, the aortic insufficiency group showed significant dilatation of the neo-aortic sinuses. Between the two groups, the remaining echocardiographic variables remained either stable or improved at follow-up.
  
  
  CONCLUSIONS
  Pre-existing larger diameters of the aortic and pulmonary annuli in the aortic insufficiency group combined with the significantly increased left ventricular end-diastolic diameters, may predispose these patients to significant dilatation of the unsupported aortic sinuses after a Ross operation. This dilatation does not, however, lead to increase in the autograft valve insufficiency at short-term follow-up if the aortic annulus and the distal ascending aorta are tailored to the size of the pulmonary autograft. Ross operation, employing freestanding aortic root replacement technique, may therefore be recommended in adult patients with bicuspid aortic valve disease with excellent short-term results.
authors.affiliation: Speciality of Cardiothoracic Surgery, Heart and Lung Division, University Hospital, Lund, Sweden. bansi.koul@skane.se
authors.forename: Bansi
authors.initials: B
authors.lastname: Koul
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Lindholm
authors.forename: Misha
authors.initials: M
authors.lastname: Koul
authors.forename: Anders
authors.initials: A
authors.lastname: Roijer
mesh_terms: D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011664:Pulmonary Valve / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome