title: Midterm results of the Ross procedure preserving the patient's aortic root.
abstract: BACKGROUND
  Since the early 1990s, the pulmonary autograft is predominantly implanted as a freestanding root for less aortic valve regurgitation is reported. However, there is a certain risk of dilatation of the root over time potentially impairing valve function. We favor since 8 years the original subcoronary or inclusion technique to preserve the root of the patient as a restrain to dilatation.
  
  
  RESULTS
  Between June 1994 and May 2002 the subcoronary (n=228) and inclusion technique (n=17) were performed in 245 patients (191 male, 54 female), mean age 45.7+/-13.4 (15-70) years. The underlying aortic valve disease was an aortic insufficiency in n=83, stenosis in n=48, a combined aortic valve disease in n=111 and an acute endocarditis in n=19 patients. Previous aortic valve surgery was performed in n=23. Last follow-up investigations (within last year) including echocardiography was performed at a mean follow-up of 29.4+/-24.7 months (553.7 patient years). Hospital mortality was n=2, late mortality n=4 (all noncardiac). Two patients were lost to follow-up (99% complete clinical follow-up). Reoperations were necessary in n=7 valves (autograft: endocarditis n=1, malpositioning n=1, leaflet prolapse n=1; homograft: stenosis n=2, insufficiency n=2). Autograft insufficiency (AI) was AI 0 in n=154, AI I n=66, AI II n=8. The maximum/mean pressure gradient across the autograft was 6.6+/-3.4 (2.1 to 25.9)/3.6+/-1.8 (1.2 to 13.2) mm Hg, respectively. Homograft insufficiency was 0 in n=167, I in n=54, II in n=9, and III in n=1. Maximum and mean transhomograft pressure gradients were 11.7+/-6.8 (2.2 to 42.6)/6.2+/-3.8 (1.2 to 24.5) mm Hg. Most patients were NYHA class I (n=214), class II (n=19), class III (n=2). Significant aortic root dilatation was not observed.
  
  
  CONCLUSIONS
  Aortic valve replacement with a pulmonary autograft in the subcoronary or inclusion technique provides excellent hemodynamics with no root dilatation at least in a mid term postoperative period. Transhomograft pressure gradients are slightly increased. Longer term results with special emphasis on the pulmonary homograft are necessary.
authors.affiliation: Clinic of Cardiac Surgery, Institute of Medical Biometrics and Statistics, Department of Cardiology, Klinikum Schwerin, Schwerin, Germany.
authors.forename: Hans- H
authors.initials: H
authors.lastname: Sievers
authors.forename: Gerlinde
authors.initials: G
authors.lastname: Dahmen
authors.forename: Bernhard
authors.initials: B
authors.lastname: Graf
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stierle
authors.forename: Andreas
authors.initials: A
authors.lastname: Ziegler
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmidtke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000033:anatomy & histology; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000637:transplantation*; D012086:Reoperation; D015996:Survival Rate; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome